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INJECTION
INJECTION?
WHO INJECTED?
LOCATION of INJ
NEEDLE GAUGE
LENGTH of NEEDLE
TYPE OF INJ
Comment
LIDOCAINE
Lidocaine DOSE
MARCAINE
Marcaine DOSE
ANTIBIOTIC
Open ANTIBIOTIC List
Levaquin (levofloxacin) 250 mg
Rocephin (ceftriaxone) 250 mg
Rocephin (ceftriaxone)1 gram
STEROID
Open STEROID List
Dexamethasone 1mg/ml
Dexa text
Depomedrol 40mg
Depo text
Depomedrol 80mg
Depo text
Kenalog (triamcinolone acetonide) 10mg/ml
Kenalog comment
Solumedrol up to 125mg/2ml
Solu text
HYALURONIC ACID
Open HA List
Supartz
SUPARTZ
Supartz, 1st, Knee, Left
Supartz, 1st, Knee, Right
Supartz, 2nd, Knee, Left
Supartz, 2nd, Knee, Right
Supartz, 3rd, Knee, Left
Supartz, 3rd, Knee, Right
Supartz, 4th, Knee, Left
Supartz, 4th, Knee, Right
Supartz, 5th, Knee, Left
Supartz, 5th, Knee, Right
Gelsyn-3
OTHER MEDS
Open OTHER MEDS
Benadryl 50 mg
Benydryl comment
Testosterone Cyprionate
Testosterone Dosage
Toradol 15 mg/ml
Norflex 60 mg/ml
Vistaril 25mg
Epinephrine 1 ml SQ/IM
Lorazapam 2 mg/ml
Diazepam 5mg/ml
Midazolam 1 mg Versed
Lincocin 300 mg
Ondansetron (Zofran) 2 mg/ml
Dramamine 50 mg
Promethazine up to 50 mg
Compazine 10 mg/2 ml
Atrovent 1 mg
Albuterol 1 mg
Pulmicort .5/2 ml
Duoneb .5/3 mg
Clonidine 1 mg
Calcium Chloride 10%
Lasix 10 mg/ml
Hydralazine up to 20 mg
Depo-Provera 200 mg/ml
Depo-Estradiol 1 mg
Imitrex 6 mg/.5 ml
Testosterone Cypionate
Stadol 2 mg/ml
Nubain 20 mg
Mag Sulfate per 500 mg
Folate 1mg
Betamethasone 3mg
Thiamine hci 100mg
Tetanus TD
Mag Sulfate 1g/2ml
Thiamine
B12 1000mcg
Ringer Lac. Up to 1000 ml
Normal Saline 1000 ml
Flu Vaccine (Medicare Patient)
Flu Vaccine (VFC)
Flu Vaccine (All others <3)
Flu Vaccine (All others >3)
IV Push Admin. Initial Drug
IV Push Additional Drug
IV for Hydration
Airway Inhalation Treatment
Oxygen SAT
Duoneb
Budesonide/Pulmicort
Albuterol Non-Comp
Neb Set
Free Text

CALLICO PROCEDURE: Injection Medical Form

Family Practitioner

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Published: Sept. 6, 2019, 4:22 p.m.
Doctor: Dr. History Physical
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