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You Are:
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AZ-Darwin (D6930C00018)
AZ-AJAX (D8210C00003)
AZ-Artemisia (D8210C00005)
PPG-WISPer (MTX-463-I201)
PPG-Asthma (CBP-201-206)
PPG-COPD (CBP-201-207)
PrecISE
GRI-Bio (GRI-0621-IPR-02)
Clean Nano (CNM-Au8 EAP)
GSK-Nazare (223125)
NIH-Echo
Non-Clinical Trial Patient
Other
Request Type
...
Break/Fix
Request
DCR/Merge
Training
Standby Call
Returns
Orders
Access Request
Spirometer Reuse Request
<div class="control-group ticket_section"> <label class=" control-label cf_site_number_personnel_need_access_to_1422730-label " for="helpdesk_ticket_cf_site_number_personnel_need_access_to_1422730">Site number personnel need access to</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_site_number_personnel_need_access_to_1422730]" id="helpdesk_ticket_custom_field_cf_site_number_personnel_need_access_to_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_full_name_of_site_personnel_1422730-label " for="helpdesk_ticket_cf_full_name_of_site_personnel_1422730">Full name of site personnel</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_full_name_of_site_personnel_1422730]" id="helpdesk_ticket_custom_field_cf_full_name_of_site_personnel_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_email_address_of_site_personnel_1422730-label " for="helpdesk_ticket_cf_email_address_of_site_personnel_1422730">Email address of site personnel</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_email_address_of_site_personnel_1422730]" id="helpdesk_ticket_custom_field_cf_email_address_of_site_personnel_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_role_of_site_personnel_1422730-label " for="helpdesk_ticket_cf_role_of_site_personnel_1422730">Role of site personnel</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_role_of_site_personnel_1422730]" id="helpdesk_ticket_custom_field_cf_role_of_site_personnel_1422730"><option value="">...</option> <option data-id="63000475105" value="Principal Investigator">Principal Investigator</option> <option data-id="63000475106" value="Primary Study Coordinator">Primary Study Coordinator</option> <option data-id="63000475107" value="Study Coordinator">Study Coordinator</option> <option data-id="63000475108" value="Clinical Research Associate">Clinical Research Associate</option> <option data-id="63000475109" value="Sponsor / CRO">Sponsor / CRO</option></select> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_spirometer_id_1422730-label " for="helpdesk_ticket_cf_spirometer_id_1422730">Spirometer ID to be reused</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_spirometer_id_1422730]" id="helpdesk_ticket_custom_field_cf_spirometer_id_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_was_a_training_effort_done_1422730-label " for="helpdesk_ticket_cf_was_a_training_effort_done_1422730">Was this a training effort conducted by the study staff?</label> <div class="controls "> <select class=" dropdown_blank section_field" data-placeholder="..." name="helpdesk_ticket[custom_field][cf_was_a_training_effort_done_1422730]" id="helpdesk_ticket_custom_field_cf_was_a_training_effort_done_1422730"><option value="">...</option> <option data-id="63000475110" value="Yes">Yes</option> <option data-id="63000475111" value="No">No</option></select> </div> </div>
Number of ZEPHYRx Managed Devices Affected
...
1
2
3
4
5
6
<div class="control-group ticket_section"> <label class=" control-label cf_device_id_1_1422730-label " for="helpdesk_ticket_cf_device_id_1_1422730">Device ID 1</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_1_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_1_1422730" /> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_device_id_1275187_1422730-label " for="helpdesk_ticket_cf_device_id_1275187_1422730">Device ID 1</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_1275187_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_1275187_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_2_1422730-label " for="helpdesk_ticket_cf_device_id_2_1422730">Device ID 2</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_2_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_2_1422730" /> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_device_id_1155565_1422730-label " for="helpdesk_ticket_cf_device_id_1155565_1422730">Device ID 1</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_1155565_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_1155565_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_2602959_1422730-label " for="helpdesk_ticket_cf_device_id_2602959_1422730">Device ID 2</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_2602959_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_2602959_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_3_1422730-label " for="helpdesk_ticket_cf_device_id_3_1422730">Device ID 3</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_3_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_3_1422730" /> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_device_id_1317019_1422730-label " for="helpdesk_ticket_cf_device_id_1317019_1422730">Device ID 1</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_1317019_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_1317019_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_2732820_1422730-label " for="helpdesk_ticket_cf_device_id_2732820_1422730">Device ID 2</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_2732820_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_2732820_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_2117176_1422730-label " for="helpdesk_ticket_cf_device_id_2117176_1422730">Device ID 3</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_2117176_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_2117176_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_4_1422730-label " for="helpdesk_ticket_cf_device_id_4_1422730">Device ID 4</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_4_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_4_1422730" /> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_device_id_1788477_1422730-label " for="helpdesk_ticket_cf_device_id_1788477_1422730">Device ID 1</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_1788477_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_1788477_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_2609662_1422730-label " for="helpdesk_ticket_cf_device_id_2609662_1422730">Device ID 2</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_2609662_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_2609662_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_3871986_1422730-label " for="helpdesk_ticket_cf_device_id_3871986_1422730">Device ID 3</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_3871986_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_3871986_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_4935193_1422730-label " for="helpdesk_ticket_cf_device_id_4935193_1422730">Device ID 4</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_4935193_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_4935193_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_5_1422730-label " for="helpdesk_ticket_cf_device_id_5_1422730">Device ID 5</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_5_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_5_1422730" /> </div> </div>
<div class="control-group ticket_section"> <label class=" control-label cf_device_id_1694894_1422730-label " for="helpdesk_ticket_cf_device_id_1694894_1422730">Device ID 1</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_1694894_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_1694894_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_2625593_1422730-label " for="helpdesk_ticket_cf_device_id_2625593_1422730">Device ID 2</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_2625593_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_2625593_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_3493584_1422730-label " for="helpdesk_ticket_cf_device_id_3493584_1422730">Device ID 3</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_3493584_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_3493584_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_4925560_1422730-label " for="helpdesk_ticket_cf_device_id_4925560_1422730">Device ID 4</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_4925560_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_4925560_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_5973590_1422730-label " for="helpdesk_ticket_cf_device_id_5973590_1422730">Device ID 5</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_5973590_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_5973590_1422730" /> </div> </div> <div class="control-group ticket_section"> <label class=" control-label cf_device_id_6_1422730-label " for="helpdesk_ticket_cf_device_id_6_1422730">Device ID 6</label> <div class="controls "> <input class=" text section_field span12" placeholder="" type="text" name="helpdesk_ticket[custom_field][cf_device_id_6_1422730]" id="helpdesk_ticket_custom_field_cf_device_id_6_1422730" /> </div> </div>
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