2AAZF-ACCRX01RFID Module

CONFIDENTIAL AND PROPRIETARY – Intuitive Surgical Inc. Prior to use, use ACCS to verify that this is the current revision Template File: 853244 Form_Template Rev D.doc DOCUMENT: 818385-01 REVISION: C PAGE: 1 of 2 TITLE: Installation Instructions for RFID Module ACCRX01 The module will be used with the host device (model PS4000) and as such, required testing and approval is completed. Use with any other host device may or may not require additional testing and approval. Consult Hardware Compliance Engineering for assistance. The RFID module (Model: ACCRX01) includes the main block (P/N 318215), the top plate (P/N 318216), the ACCR PCA (P/N 353240-06), ACCRA PCA (P/N 343460-05), the pod support (P/N 318273), and board support (P/N 318230). The module will be labeled to identify FCC ID (2AAZF-ACCRX01), IC ID (11508A- ACCRX01), and Model (ACCRX01). The label is P/N 510196-01, having white background with black text, and must be attached in a manner such that it will remain fastened to the device during the expected life of the product. The “minimum size and font” is that the text must be legible. Label will be applied on the main carriage block near the ACCR location. It will not be visible when installed on host location. This is acceptable because the approval ID information will be marked on the rear vent panel of the host device. The intentional radiator symbol will be included with the approval ID information (refer to 880175-02) on the host device, as required per EN60601-1-2. This marking will be readily visible to the user of the host device without the use of tools. Note: Statements below that are within quotation marks have fixed wording. FCC The host product must be labeled with the following: “Contains FCC ID: 2AAZF-ACCRX01” The host product manual must include following statements: “This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation.” Changes or modifications, not expressly approved by Intuitive Surgical, may void the user‟s authority to operate the equipment. (Note: the wording for this statement is not fixed) CONFIDENTIAL AND PROPRIETARY – Intuitive Surgical Inc. Prior to use, use ACCS to verify that this is the current revision Template File: 853244 Form_Template Rev D.doc DOCUMENT: 818385-01 REVISION: C PAGE: 2 of 2 TITLE: Installation Instructions for RFID Module ACCRX01 Industry Canada The host product must be labeled with the following: “Contains IC: 11508A-ACCRX01” The host product manual must include following statements: “Under Industry Canada regulations, this radio transmitter may only operate using an antenna of a type and maximum (or lesser) gain approved for the transmitter by Industry Canada. To reduce potential radio interference to other users, the antenna type and its gain should be so chosen that the equivalent isotropically radiated power (eirp) is not more than necessary for successful communication.” “This device complies with Industry Canada license-exempt RSS standard(s). Operation is subject to the following two conditions: (1) this device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation.” "Conformément à la réglementation d'Industrie Canada, cet émetteur radio peut fonctionner uniquement à l'aide d'une antenne de type et de gain maximum (ou moindre) approuvés pour l'émetteur par Industrie Canada. Pour réduire le risque d'interférence aux autres utilisateurs, le type d'antenne et son gain doivent être choisis afin que la puissance isotrope rayonnée équivalente (PIRE) n„excède pas celle nécessaire à une communication réussie ". "Cet appareil est conforme au(x) standard(s) des CNR d‟Industrie Canada pour appareils radio exempt(s) de licence . Son fonctionnement est soumis aux deux conditions suivantes: (1) ce dispositif ne doit pas causer d'interférences nuisibles, et (2) cet appareil doit accepter toute interférence reçue, y compris les interférences qui peuvent provoquer un fonctionnement indésirable ".

Page 1 of 1 National Technical Systems – Silicon Valley TCB 41039 Boyce Road Fremont, CA. 94538 RE: FCC/IC application for FCC ID: 2AAZF-ACCRX01, IC:11508A-ACCRX01 To whom it may concern: The enclosed documents constitute a formal submittal and application for Equipment Authorization for a RFID module operating at 13.56MHz pursuant to the following rules: Subpart C of Part 15 of FCC Rules (CFR 47), Intentional Radiators RSS-Gen Issue 3, December 2010, “General Requirements and Information for the Certification of Radiocommunication Equipment” RSS-210, Issue 8, December 2010, “Low-power Licence-exempt Radiocommunication Devices (All Frequency Bands): Category I Equipment” The application is for a limited modular approval, with the limitation is that module is to used only in products developed by applicant, Intuitive Surgical. National Technical Systems – Silicon Valley, as duly authorized agent prepared this submittal. A copy of the letter of our appointment as agent is included with the application. If there are any questions or if further information is needed, please contact National Technical Systems – Silicon Valley for assistance. Sincerely, Mark Hill Staff Engineer

Label Drawing & Location Drawing The module is appropriately labeled (content is shown in Figure 1). Labels are attached in a manner such that they will remain fastened to the device during the expected life of the product. The “minimum size” is that the text must be legible. Module label is on main carriage block housing (refer to Figure 2) and will not be visible when carriage cover is installed, however the approval ID information will be visible the rear vent panel label (refer to Figure 3). Label with approval ID information is readily visible to the user of the device without the use of tools. Instructions to the end user regarding the labeling requirements for host devices are included in this application. Figure 1. Module label content Figure 2. Image of module label location on main carriage block Figure 3. RFID Product Label on PSC Vent Panel

File: R93875 Rev 2 Page 1 EMC Test Report Application for Grant of Equipment Authorization Industry Canada RSS-Gen Issue 3 / RSS 210 Issue 8 FCC Part 15 Subpart C RFID Model ACCRX01 IC CERTIFICATION #: 11508A-ACCRX01 FCC ID: 2AAZF-ACCRX01 APPLICANT: Intuitive Surgical Inc. 1266 Kifer Road Sunnyvale, CA 94086 TEST SITE(S): National Technical Systems - Silicon Valley 41039 Boyce Road. Fremont, CA. 94538-2435 IC SITE REGISTRATION #: 2845B-3, 2845B-4 REPORT DATE: December 26, 2013 REISSUE DATE: January 15, 2013 FINAL TEST DATES: November 8 and 13 and December 6, 2013 TOTAL NUMBER OF PAGES: 34 PROGRAM MGR / QUALITY ASSURANCE DELEGATE / TECHNICAL REVIEWER: FINAL REPORT PREPARER: ______________________________ ______________________________ Mark E Hill David Guidotti Staff Engineer Senior Technical Writer National Technical Systems - Silicon Valley is accredited by the A2LA, certificate number 0214.26, to perform the test(s) listed in this report, except where noted otherwise. This report and the information contained herein represent the results of testing test articles identified and selected by the client performed to specifications and/or procedures selected by the client. National Technical Systems (NTS) makes no representations, expressed or implied, that such testing is adequate (or inadequate) to demonstrate efficiency, performance, reliability, or any other characteristic of the articles being tested, or similar products. This report should not be relied upon as an endorsement or certification by NTS of the equipment tested, nor does it represent any statement whatsoever as to its merchantability or fitness of the test article, or similar products, for a particular purpose. This report shall not be reproduced except in full National Technical Systems - Silicon Valley -- EMC Department Test Report Report Date: December 26, 2013 Reissue Date: January 15, 2013 File: R93875 Rev 2 Page 2 REVISION HISTORY Rev# Date Comments Modified By - 12/26/2013 First release 1 12/31/2013 Reissued to correct test dates on pages 1 and 8 Dave Guidotti 2 1/15/2014 Corrected RSS-GEN/RSS-210 Standard references Dave Guidotti Mark Hill National Technical Systems - Silicon Valley -- EMC Department Test Report Report Date: December 26, 2013 Reissue Date: January 15, 2013 File: R93875 Rev 2 Page 3 TABLE OF CONTENTS REVISION HISTORY ................................................................................................................................................ 2 TABLE OF CONTENTS ............................................................................................................................................ 3 SCOPE .......................................................................................................................................................................... 4 OBJECTIVE ................................................................................................................................................................ 4 STATEMENT OF COMPLIANCE ........................................................................................................................... 5 DEVIATIONS FROM THE STANDARDS .............................................................................................................. 5 TEST RESULTS SUMMARY ................................................................................................................................... 6 DEVICES OPERATING UNDER THE GENERAL LIMITS ................................................................................. 6 GENERAL REQUIREMENTS APPLICABLE TO ALL BANDS .......................................................................... 6 MEASUREMENT UNCERTAINTIES .................................................................................................................... 7 EQUIPMENT UNDER TEST (EUT) DETAILS ...................................................................................................... 8 GENERAL ................................................................................................................................................................ 8 ANTENNA SYSTEM .............................................................................................................................................. 8 ENCLOSURE ........................................................................................................................................................... 8 MODIFICATIONS ................................................................................................................................................... 8 SUPPORT EQUIPMENT ......................................................................................................................................... 8 EUT INTERFACE PORTS ...................................................................................................................................... 9 EUT OPERATION ................................................................................................................................................... 9 TEST SITE ................................................................................................................................................................. 10 GENERAL INFORMATION ................................................................................................................................. 10 CONDUCTED EMISSIONS CONSIDERATIONS .............................................................................................. 10 RADIATED EMISSIONS CONSIDERATIONS .................................................................................................. 10 MEASUREMENT INSTRUMENTATION ............................................................................................................ 11 RECEIVER SYSTEM ....................................................................................................................…

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RE radio Horizontal RE Radio Side RE Radio Vertical CE RFID CE RFID