|
1. ASH
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
2. BIRCH
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
3. BOX ELDER
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
4. CEDAR
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
5. COTTONWOOD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
6. ELM AMERICAN
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
7. ELM SIBERIAN
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
8. JUNIPER
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
9. LINDEN
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
10. MAPLE
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
11. MESQUTTE
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
12. MULBERRY
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
13. OAK, GAMBLE
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
14. OLIVE, RUSSIAN
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
15. PECAN
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
16. SYCAMORE
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
17. TAMARISK
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
18. WALNUT
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
19. WILLOW
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
1. BERMUDA STD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
2. KENTUCKY BLUE STD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
3. TIMOTHY STD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
4. Johnson Grass
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
Salt Lake Mail Out
|
|
|
1. ALFALFA
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
2. DOCK
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
3. FALSE RAGWEED
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
4. GIANT MARSHELDER
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
5. KOCHIA
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
6. LAMBS QUARTERS
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
7. PIGWEED
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
8. PLANTAIN
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
9. RABBIT BUSH
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
10. RAGWEED, WETERN
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
11. RUSSIAN THISTLE
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
12. COMMON SAGEBRUSH
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
13. WINGSCALE
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
14. MAJOR WEED MIX
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
1. ALTERNARIA
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
2. ASPERGIULUS
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
3. CLADOSPORIUM
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
4. HELMINTHOSPORIUM
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
5. PENIOLLIUM
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
1. CAT STD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
2. CATTLE
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
3. DOG- AP
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
4. FEATHERS
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
5. HORSE -AP
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
6. HD MITE D FARINA STD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
7. HD MITE D PTERO STD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
8. H DUST MITE MIX STD
|
|
|
Vol.
|
100cc Refill Date
|
|
Change Date
|
Change Date
|
|
|
|
|
SUBTOTAL EXTRACT VOLUME
|
Saline/ALB/Phenol
|
|
Total Volume
|
Prior Injections, Doctor request
|
|
Antihistamine
|
Peak Flow Target
|
|
Special Instructions
|
|
