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Shot Clinic
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Patient's Stock? If yes slide Admin Fee below
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Administration fee - Insurance
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Administered by
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One Time Only
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PT Must be seen before next injection
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Administered By
• • •
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Site
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Route
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B-12 5000mcg (Methylcobalamin)
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Comments
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Reaction
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Estrogen 5 Mg/mL
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Volume (cc / ml)
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Reaction
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Comments
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(E3) Estriol 10 Mg/mL (1 mL)
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(E3) Estriol 10 Mg/mL (2 mL)
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Progesterone
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Volume (cc/mL)
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Reaction
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Comments
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Testosterone Cypionate
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Volume (cc/mL)
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Reaction
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Comments
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Depo-Medrol Injection (1 mL)
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Depo-Medrol Inj Dx
• • •
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Dexamethasone Injection (1 mL)
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Dexamethasone Inj Dx
• • •
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Other Drug - Description/Amount
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Site
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Route
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Reaction
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Comments
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Shot Clinic: Female T
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Shot Clinic: Male - 1 cc T
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Shot Clinic: Female EPT
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Shot Clinic: Male - 2 cc T
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Shot Clinic: Female ET
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Shot Clinic: Male - 2.5 cc T
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Shot Clinic: Female PT
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Shot Clinic: Male - 3 cc T
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