Establishing secure connection…Loading editor…Preparing document…

Medical Imaging Probe

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

MEDICAL IMAGING PROBE AGREEMENT

This Medical Imaging Probe Agreement (the Agreement) is made effective as of by and between:

WHEREAS

1. Provider is engaged in the design, manufacture and sale of medical imaging probes and owns or controls proprietary designs, specifications and quality standards for the probe identified herein (the Probe).

2. Client desires to acquire the Probe and related services for clinical use in accordance with the specifications, delivery and acceptance terms set forth in this Agreement; Provider is willing to supply the Probe and perform the related services under the terms and conditions set forth below.

3. The parties intend by this Agreement to describe the scope of work, payment, delivery, acceptance testing, confidentiality, and other commercial and legal terms that will govern their relationship with respect to the Probe.

PROBE IDENTIFICATION

Model:    Serial No.:    Quantity:

SCOPE OF WORK

Provider shall deliver, install (if applicable), commission and perform acceptance testing of the Probe in accordance with the scope and schedule below. Provider shall also provide required documentation, user instructions and training as specified.

DELIVERY AND ACCEPTANCE

Estimated Delivery Date:    Acceptance Testing Period (days):

Acceptance Criteria: Client shall conduct acceptance testing in accordance with the acceptance test protocol provided by Provider. If the Probe materially fails acceptance testing, Client shall notify Provider in writing within the acceptance testing period and Provider shall, at Provider's option, repair, replace or refund the purchase price for the non-conforming Probe.

PAYMENT TERMS

Invoices are payable within days of invoice date. Late payments shall incur a late fee of % per month on the outstanding balance, or the maximum permitted by law, whichever is less.

All payments shall be made in United States Dollars and are exclusive of taxes. Client shall be responsible for all applicable sales, use, value-added or similar taxes, excluding taxes based on Provider's net income.

TERM AND TERMINATION

This Agreement shall commence on the Start Date: and shall continue until End Date: , unless earlier terminated in accordance with this Section.

Either party may terminate this Agreement for material breach by the other party if the breaching party fails to cure such breach within days after receipt of written notice. Either party may terminate for convenience upon days' prior written notice.

Upon termination, Client will return or, at Provider's direction, destroy all Provider Confidential Information and, if applicable, the Probe in accordance with the return and disposition procedures set forth in this Agreement; Provider shall invoice Client for any unpaid amounts due for goods and services provided prior to termination.

CONFIDENTIALITY

Each party (the Receiving Party) shall keep confidential all non-public technical, business and clinical information disclosed by the other party (the Disclosing Party) and designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure. Confidential Information shall not include information that (i) is or becomes publicly known through no breach of this Agreement by the Receiving Party; (ii) is received from a third party without breach of any obligation of confidentiality; or (iii) is independently developed by the Receiving Party without use of or reference to the Disclosing Party's Confidential Information.

The Receiving Party may disclose Confidential Information as required by law or to its employees and contractors who have a need to know, provided such persons are bound by confidentiality obligations no less protective than those set forth herein. The Receiving Party will take reasonable measures to protect the Disclosing Party's Confidential Information.

WARRANTIES; DISCLAIMERS

Provider warrants that, at the time of delivery, the Probe will materially conform to the specifications set forth in this Agreement and will be free from material defects in materials and workmanship for a period of months from acceptance.

The foregoing warranty is exclusive and in lieu of all other warranties, express or implied, including implied warranties of merchantability and fitness for a particular purpose, except to the extent such disclaimers are not permitted by applicable law.

INDEMNIFICATION AND LIMITATION OF LIABILITY

Provider shall indemnify and hold harmless Client from and against third-party claims arising out of Provider's gross negligence or willful misconduct in connection with the manufacture or delivery of the Probe. Client shall indemnify and hold harmless Provider from and against third-party claims arising out of Client's misuse of the Probe or Client's failure to follow Provider's instructions.

IN NO EVENT SHALL EITHER PARTY'S AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AGREEMENT EXCEED THE TOTAL AMOUNTS PAID OR PAYABLE BY CLIENT TO PROVIDER UNDER THIS AGREEMENT IN THE TWELVE (12) MONTHS PRECEDING THE CLAIM. NEITHER PARTY SHALL BE LIABLE FOR CONSEQUENTIAL, INCIDENTAL, SPECIAL, OR PUNITIVE DAMAGES, EXCEPT FOR LIABILITY ARISING FROM A PARTY'S GROSS NEGLIGENCE OR WILLFUL MISCONDUCT.

COMPLIANCE WITH LAWS

Each party shall comply with all applicable federal, state and local laws, rules and regulations in the performance of its obligations under this Agreement, including applicable laws governing medical devices, export controls, and patient privacy to the extent applicable.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles.

ENTIRE AGREEMENT

This Agreement, together with any attachments, exhibits and purchase order terms expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, and communications, whether written or oral, relating to the Probe. Any amendment or modification must be in writing signed by authorized representatives of both parties.

MISCELLANEOUS

Notices required under this Agreement shall be given in writing and delivered to the contact addresses provided above. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Provider - Printed Name:

By:

Date:

Client - Printed Name:

By:

Date:

Enter text✕
Prepare your document for signing right on this page
  • 01 Edit the text and complete the fields
  • 02 Click Sign Now and on the next screen add recipients and signature fields in SignNow
  • 03 Start your free trial to sign and send your doc
Sign Now

What the Medical Imaging Probe record is and when it’s used

The Medical Imaging Probe document is a standardized record for capturing technical specifications, serial and model identifiers, calibration and maintenance history, safety checks, and regulatory status for imaging probes (for example ultrasound transducers or endoscopic camera probes). It is used by clinical engineering, biomedical technicians, and procurement teams to verify device readiness, track repairs, and support adverse event reporting and warranty claims.

Why an accurate Medical Imaging Probe record matters

A complete record reduces clinical downtime, supports patient safety, preserves warranty rights, and creates the audit trail needed for regulatory reporting and internal quality management systems.

Why an accurate Medical Imaging Probe record matters

Who typically creates and relies on the probe record

Multiple stakeholders interact with this form across device lifecycle: clinical engineering, radiology, procurement, and quality/compliance teams.

  • Clinical Engineering — Performs calibration, functional tests, and documents maintenance actions and test results to ensure safe clinical operation.
  • Radiology / Sonography Teams — Record device condition at point of care and note any clinical artifacts or imaging anomalies.
  • Procurement / Supplies — Use model, serial, and vendor fields to reconcile warranties, replacement parts, and purchase records.

Clear role separation and accurate entries reduce rework, speed repairs, and simplify audit responses.

Primary signers and approvers

Biomedical Engineer

A biomedical engineer or certified technician usually performs inspections, records calibration results, and signs to attest operational readiness. Their entry should include credentials, department, and contact information for traceability and follow-up.

Department Supervisor

A supervising clinician or department manager signs to accept the device for clinical use after maintenance. That signature documents authorization to return the probe to service and ties the record to clinical responsibility.

Core sections every professional probe record should include

A well-structured record captures identification, technical specs, inspection results, service history, regulatory notes, and attachments so it supports clinical, maintenance, and audit needs.

Device ID

Manufacturer, model, serial number, and part numbers. Accurate identifiers link the probe to warranty, recalls, and device-specific maintenance procedures.

Technical Specs

Frequency range, connector type, cable length, and device limits. These details guide compatibility checks and replacement ordering.

Calibration & Tests

Dates, test results, calibration tolerances, and instrument used. Include pass/fail status and corrective actions taken when outside tolerance.

Service History

Work order numbers, technician name, repair descriptions, replaced parts, and cost centers to support accounting and warranty claims.

Safety Checks

Leak tests, insulation checks, and visual inspection results. Document infection control cleaning status and sterilization method if applicable.

Attachments

Photographs, service invoices, vendor certificates, and manufacturer recalls or advisories appended as supporting evidence.

Security and compliance elements to include

Access Control: Role-based access
Audit Trail: Immutable signing log
Encryption: TLS 1.2/1.3
Data at Rest: AES-256 encryption
HIPAA Controls: BAA when PHI present
Versioning: Retain historical copies

Step-by-step: completing the Medical Imaging Probe record

Follow this sequence to ensure the record is complete, auditable, and ready for e-signature and filing.

  • 01
    Identify Device: Enter manufacturer, model, and serial number.
  • 02
    Perform Inspection: Run required functional and safety tests.
  • 03
    Document Findings: Record measured values and any repairs.
  • 04
    Sign and Archive: Sign, attach supporting files, and store per policy.

Typical e-submission workflow for probe records

An electronic workflow improves traceability and reduces turnaround time for repairs and approvals.

  • Upload: Attach the completed form and supporting documents.
  • Assign: Route to technician or reviewer for approval.
  • Sign: Apply e-signature with authentication as required.
  • Store: Archive to device record management system.

Recommended online configuration for efficient processing

Configure fields, authentication, and routing to match your quality system and regulatory obligations.

Field Configuration
Device ID Required, read-only after save
Inspection Checklist Conditional required if fail detected
Approver Role-based signer, email or SSO
Attachments Allow PDF, JPG, DOCX

Technical and platform considerations for e-submission

Verify vendor certifications and BAAs for protected health information before enabling electronic workflows.

  • File Formats: PDF, DOCX
  • Integrations: HL7/EMR optional
  • Authenticator: Email or SMS code

Key timing windows and regulatory deadlines to track

Maintain a schedule for routine service, warranty claims, and required regulatory reporting to avoid penalties and patient impact.

Routine calibration interval:

Typically every 6–12 months depending on vendor guidance

Preventive maintenance schedule:

Follow manufacturer intervals to preserve warranty coverage

Warranty claim deadline:

Submit within vendor-specified warranty period

Adverse event reporting:

Report to FDA per 21 CFR 803 timelines when required

Record retention review:

Annual audit of device records and attachments

Common preparation errors to avoid

  • Using inconsistent serial or model formats that prevent matching to vendor recall lists and void warranty verification.
  • Omitting attachments such as repair invoices or calibration certificates, which leads to incomplete audit trails and delayed approvals.
  • Failing to document corrective actions when tests are out of tolerance, exposing the facility to repeat failures or liability.
  • Allowing unverified guest signers without sufficient authentication, which weakens attribution for regulatory or legal reviews.

Short risks and consequences of incomplete or incorrect records

Patient Safety: Increased harm risk
Warranty Loss: Rejected claims
Regulatory Action: FDA scrutiny
Operational Downtime: Delayed imaging services
Financial Exposure: Repair costs
Data Breach: HIPAA violation

Representative use cases for Medical Imaging Probe records

Two concise scenarios show how the record supports clinical, maintenance, and compliance workflows.

Hospital Repair Workflow

A radiology department logs a failed probe and attaches photos and test data to the record to initiate repair order.

  • Technician records serial and repair steps during service.
  • Complete records enabled faster warranty reimbursement, quicker return to service, and a clear audit trail for the quality department.

Clinical Trial Asset Management

A research site inventories probes used in a multicenter study and records calibration results before each imaging session.

  • Records link to participant visit IDs.
  • Central study monitors access unified documentation for device condition, reducing queries during monitoring visits and protecting data integrity.

Milestones from intake to archive for a probe record

Track these sequential stages to ensure full lifecycle control from receipt to long-term retention.

01

Intake and Identification

Record device identifiers and initial condition upon receipt for the asset register.

02

Inspection and Testing

Perform functional and safety checks and document numeric results and pass/fail outcomes.

03

Repair and Verification

Complete repairs, replace parts, and re-test to verify restored function before return to service.

04

Archive and Retention

Store signed record and attachments in device management system per retention policy.

Paper vs electronic records: quick capability comparison

Compare essential attributes so you can choose the format that meets operational and regulatory needs.

Format Paper Electronic
Signature acceptance manual ink e-signature with audit
Audit trail limited detailed log
Storage physical file encrypted archive
Submission time slower faster
Regulatory acceptance accepted accepted (esign/ueta)

Typical eSignature vendor comparison for Medical Imaging Probe records

Vendor pricing and feature availability vary; choose a vendor that meets your compliance needs, including HIPAA and audit trails, while fitting your budget.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes (Premium) Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies by plan Varies Varies

Best practices for accurate, auditable probe records

Apply consistent procedures and controls to minimize errors and support regulatory compliance across device lifecycles.

Standardize Templates
Use a single agreed template with required fields to ensure consistent data capture across teams and sites.
Enforce Authentication
Require role-based signers and multifactor authentication for approvals that affect device readiness or patient care.
Attach Evidence
Always upload photos, calibration certificates, and invoices to support entries and expedite warranty or regulatory inquiries.
Audit Regularly
Schedule periodic audits of records and signature logs to detect missing entries and ensure retention policy compliance.

Frequently asked questions about Medical Imaging Probe records and e-signatures

Answers to common questions on e-signing, retention, and regulatory obligations when documenting imaging probe maintenance and repairs.


Need help? Contact support

Export, attachments, and version control options

Ensure export formats and versioning support audits, vendor claims, and long-term archival.

Export Formats

Save final signed records as PDF/A for long-term archiving; also allow DOCX exports for editable templates and CSV for aggregated device inventories.

Supporting Documents

Include calibration certificates, invoices, and photos as embedded PDFs to maintain a single device record for audits and warranty claims.

Version Control

Keep an immutable history of prior versions and make the active version clearly identifiable to prevent use of outdated maintenance instructions.

Audit & Traceability

Record IP, timestamps, and signer identity with each action so events can be reconstructed during compliance reviews.

be ready to get more
Join over 28 million airSlate SignNow users
Sign Now
Company
Forms
Pricing
Resources
Knowledge base
Other Products
© 2026 airSlate Inc. All rights reserved.