|
Injectable
• • •
|
|
|
Area Injected
• • •
|
Lot/ Expiration
|
|
Injection #
• • •
|
# Injections in Series
• • •
|
|
Cold Spray?
• • •
|
cc Lidocaine used
|
|
Imaging Method
• • •
|
Needle Used
• • •
|
|
Approach
• • •
|
|
|
Contrast Agent
• • •
|
|
|
Fluid Aspirated [-]
|
Volume of Fluid Aspirated
|
|
Aspirate Description
• • •
|
Custom Fluid Description
|
|
Fluid sent for analysis?
|
Ozone Volume
• • •
|
|
VS Injected?
|
|
|
Intraarticular PRP? cc injected
• • •
|
Extraarticular PRP? cc injected
• • •
|
|
Sarapin Volume
• • •
|
Custom Comments
|
|
Closer.
|
|
|
2nd Joint Injection (Same Day)
|
|
|
Injectable
• • •
|
Lot/ Expiration
|
|
Joint Injected
• • •
|
|
|
Injection #
• • •
|
# Injections in Series
• • •
|
|
Cold spray?
• • •
|
cc Lidocaine used
|
|
Imaging Method
• • •
|
Needle Used
• • •
|
|
Approach
• • •
|
|
|
Contrast Agent
• • •
|
Volume of Fluid Aspirated
|
|
Fluid Aspirated [-]
|
Custom Fluid Description
|
|
Aspirate Description
• • •
|
|
|
Fluid sent for analysis?
|
Ozone Volume
• • •
|
|
VS Injected?
|
|
|
Intraarticular PRP? cc injected
• • •
|
Extraarticular PRP? cc injected
• • •
|
|
Sarapin Volume
• • •
|
Custom Comments
|
|
|
|
|
Closer.
|
|
