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Session #
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Reported Chief Complaint/Symptoms Experienced
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|
Female Question Set
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Is the patient pregnant?
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Type of K session
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Ketamine Route of Admin
• • •
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Ketamine Dose Administered in mg
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Effects experienced from Ketamine (what emerged during session, subjective and observable)
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PRN medications given
• • •
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Side Effects noted
• • •
|
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Response to any PRN medications
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Orientation
• • •
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Gait
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If gait not normal at discharge, explain:
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IPC KAP driving policy understood and accepted.
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|
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Patient agreed not to drive until the next day.
|
|
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Disposition
• • •
|
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