Please check the required fields
Email address of issuing person.
Chair Id Number
Please enter Barcode number on chair.
Chair issued to who... First Name
Chair issued to who... Last Name
Does this person have a suffix?
What room is this resident assigned to?
Non-Resident Room aka perminant non resident assignment
Resident room number...
The following accessories were added at time of issue.
Stationary left leg rest
Stationary right leg rest
Elevated left leg rest
Elevated right leg rest
Back up automatic breaking system
Was additional padding added? If so what kind?
If none state "None"
Notes for file...
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