res or Defibrillator if yes, make\ year Ear Implants or Hearing Aids Electrical Stimulators Implant/Prosthesis Infusion Pumps Coils. Catheters, Filters or Wires in blood • Artifical Limbs or Joint Replacement Tattooed Eyeliner Artificial Heart Valves Stents If yes, please provide date of implant: Magnet

fragment or foreign body O Ear Implants or Hearing Aids O Electrical Stimulators O Implant/Prosthesis O Infusion Pumps 0 Coils. Catheters. Filters or Wires in blood O Artifical Limbs or Joint Replacement O Tattooed Eyeliner O Artificial Heart Valves O Stents If yes, please provide date of implant

n body CI O Ear Implants or Hearing Aids 0 C7 Electrical Stimulators 0 0 Implant/Prosthesis CI 0 Infusion Pumps 0 0 Coils. Catheters. Filters or Wires in blood 0 0 Artifical Limbs or Joint Replacement CI 0 Tattooed Eyeliner 0 O Artificial Heart Valves 0 0 Stents If yes, please provide d