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Please turn on
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IV SOLUTION - Magnesium Chloride Hexahydriat
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Lot Number
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Expiration
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Meyers Cocktail Concentrate
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Lot Number
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Expiration
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Hydroxocobalamin 1-2mg/ml (B12)
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Lot Number
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Expiration
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Calcium Gluconate 0.465 meg/L
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Lot Number
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Expiration
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Pyridoxine HCL 100 mg/ml
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Lot Number
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Expiration
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Dexpanthenol 250mg/ml
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Lot Number
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Expiration
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B-Complex 100
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Lot Number
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Expiration
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Vitamin C 500mg/ml
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Lot Number
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Expiration
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IV Glutathione 200mg/ml
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Lot Number
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Expiration
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All vitamins/minerals are added to
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DATE
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PATIENT SIGNATURE
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Procedure: INTRAVENOUS NUTRITIONAL THERAPY IV:__
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NS
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A total volume of ____ CC was infused
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