MRI   CT  Other

Currently Scanning:  YES   NO

Date of Manufacture:    2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980

Lien/Lease Payoff if any:



Equipment Physical Condition:       1 2 3 4 5 6 7 8 9 10

Equipment Mechanical Condition:  1 2 3 4 5 6 7 8 9 10

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