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MD ORDER
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IV PREPARED BY:
• • •
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PROGRESS NOTE
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ALLERGIES
• • •
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ALLERGIES (OTHER)
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PREGNANT?
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FAINTING WITH NEEDLES/SHOTS?
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In sterile fashion draw each of the nutrients be
• • •
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NAD+ (50MF/ML) - 5 ml - 250 mg MG
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NAD+ (100 MF/ML) - 5 ML OR 500 MG
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NAD+ (50 MF/ML) - 10 ML OR 500 MG
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AMINO ACID BLEND 10% - 100 ML
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AMINO ACID BLEND 10% - 200 ML
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AMINO ACID BLEND 10% - 500 ML
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1.Additional Nutrient & Dose/mL
• • •
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1. # mL
• • •
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2. Additional Nutrient & Dose/ml
• • •
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2. # mL
• • •
|
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3. Additional Nutrient & Dose/ml
• • •
|
3. # mL
• • •
|
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4. Additional Nutrient & Dose/ml
• • •
|
4. # mL
• • •
|
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5. Additional Nutrient & Dose/ml
• • •
|
5. # mL
• • •
|
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SITE OF IV
• • •
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IV Started By:
• • •
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ANGIOCATH SIZE
• • •
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TIME IV ENDED
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TIME IV STARTED
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ENDING BLOOD PRESSURE
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STARTING BLOOD PRESSURE
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ENDING HR
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STARTING HR
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ENDING TEMPERATURE
|
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STARTING TEMPERATURE
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ADDITIONAL INFUSION COMMENTS
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INFUSION NOTE
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ADDITIONAL DISCHARGE COMMENTS
|
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IV DISCHARGE NOTE
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FOLLOW-UP
|
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PORTACATH NOTE
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