|
Injectable
• • •
|
Lot/ Expiration
|
|
Area Injected
|
|
|
Injection #
• • •
|
# Injections in Series
• • •
|
|
cc Lidocaine used
|
|
|
Imaging Method
• • •
|
|
|
Approach
• • •
|
|
|
Needle Used
• • •
|
|
|
What was injected?
|
Volume of Fluid Aspirated
|
|
PRP? cc injected
• • •
|
Custom Fluid Description
|
|
Sarapin Volume
• • •
|
|
|
Ozone Volume
• • •
|
Custom Comments
|
|
Injection Site
|
|
|
Closer.
|
|
|
|
|
|
2nd Joint Injection (Same Day)
|
|
|
Injectable
• • •
|
Lot/ Expiration
|
|
Area Injected
|
Custom Fluid Description
|
|
Injection #
• • •
|
# Injections in Series
• • •
|
|
cc Lidocaine used
|
|
|
Imaging Method
• • •
|
|
|
Approach
• • •
|
|
|
|
|
|
Needle Used
• • •
|
Custom Comments
|
|
PRP? cc injected
• • •
|
Extraarticular PRP? cc injected
• • •
|
|
Sarapin Volume
• • •
|
|
|
Ozone Volume
• • •
|
|
|
Injection Site
|
|
|
Closer.
|
|
