• Call: (844) 569-8628
  • |
  • Get a Quote
  • |
  • COVID-19 Updates
  • |
  • Log In
DrChrono gray logo
  • Solutions
    • Providers
    • EHR by Specialty
    • Telemedicine
    • Large Practice
    • Small Practice
    • Multi Specialty

    • Patients
    • Patient Portal - OnPatient

    • Partners & Affiliates
    • Become a Partner
    • API Developers
    • Affiliate Information
    • Apple Mobility Program
  • Platform
    • Product
    • Electronic Health Records
    • Telehealth
    • Practice Management
    • Medical Billing
    • Revenue Cycle Management
    • Patient Portal
    • Mobile EHR Solutions
    • App Marketplace

    • Features
    • All Features
    • Lab & Imaging
    • eRx & EPCS
    • Medical Templates
    • Feature videos
  • Resources
    • Resources & Tools
    • Resources
    • Case Studies
    • Blog
    • Specialties
    • Testimonials
    • Webinars
    • Plans
    • ONC Certification

    • Customer Help
    • Support Center
    • Training videos
  • Company
    • About Us
    • Blog
    • Diversity
    • Life & Culture
    • Press
  • Telehealth
  • Try Now
DrChrono gray logo mobile menu icon
Close out of menu icon
  • Solutions
    • Providers
    • EHR by Specialty
    • Telemedicine
    • Large Practice
    • Small Practice
    • Multi Specialty

    • Patients
    • Patient Portal - OnPatient

    • Partners & Affiliates
    • Become a Partner
    • API Developers
    • Affiliate Information
    • Apple Mobility Program
  • Platform
    • Product
    • Electronic Health Records
    • Telehealth
    • Practice Management
    • Medical Billing
    • Revenue Cycle Management
    • Patient Portal
    • Mobile EHR Solutions
    • App Marketplace

    • Features
    • All Features
    • Lab & Imaging
    • eRx & EPCS
    • Medical Templates
    • Feature videos
  • Resources
    • Resources & Tools
    • Resources
    • Case Studies
    • Blog
    • Specialties
    • Testimonials
    • Webinars
    • Plans
    • ONC Certification

    • Customer Help
    • Support Center
    • Training videos
  • Company
    • About Us
    • Blog
    • Diversity
    • Life & Culture
    • Press
  • Try Now Log In
IV Title
Blood Draw Title
IV or Blood Draw Selected
• • •
Bag Size
Administered By
IV Placement
• • •
Payment
Complications
• • •
First Time IV
Successful Procedure
Base Bag
Medications Add Ons
• • •
Liquid Money
Energy
Immunity
Beauty
Detox
Relax
PostOp
PreOp
Blue IV
ALA Bag
Bag Additions
• • •
Additional Notes
B12 (methylcobalamin)
Custom Bag Ingredients
Oxytocin (10IU/ml)
Vitamin C (500mg/ml)
Procaine 2% (ml)
Carnitine (500mg/ml)
Glutathione (300mg/ml)
Glycine (100mg/ml)
Taurine (50mg/ml)
Arginine (500mg/ml)
Folic Acid (10mg/ml)
Ca Glucornate 10% (10mg/ml)
Mag Cl (200mg/ml)
Dexpanthenol (250mg/ml)
Pyridoxine (100mg/ml)
PC (50mg/ml)
Lidocaine 2% (ml)
DMSO 99.9% (ml)
Sodium Bicarbonate 8.4% (ml)
MSM (150mg/ml)
CA EDTA (300mg/ml)
CoQ10 (1.5 mg/ml)
Ribose - 5 - Phosphate (50mg/ml)
Glycyrrhic (8mg/ml)
D Ribose (15mg/ml)
Selenium (200mcg/ml)
Lipoic Acid (25mg/ml)
Thiamine (200mcg/ml)
NAC (100mg/ml)
Vitamin A (50,000U/ml)
Vitamin D3 (400,000IU/ml)
Thymus (5mg/ml)
Vitamin D3 (5000IU/ml)
Tryptophan (10mg/ml)
Glutathione (300mg/ml)
Taurine (50mg/ml)
Zinc Cl (10mg/ml)
Ornithine (100mg/ml)
NADH (100mg/ml)
Vitamin E (250IU/ml)
B Complex (1mg/ml)
Bag Thermic
Bag Libido
Base Bag Additions
Energy Shot
• • •
Repeat IV

JLINBLOOD Medical Form

General Practice

There are 0 copies in use.
Published: July 16, 2021, 1:29 p.m.
Doctor: Dr. History Physical
Rating: 0   /

Use this form Back to list

Download JLINBLOOD

If you have an account, log in to use or rate this form. Log In

Click to use an int'l or other #

Don't have an account? Sign up to use this form. Sign Up

Close
DrChrono white logo

328 Gibraltar Dr
Sunnyvale, CA 94089

Call us: (844) 569-8628

Apple app store logo
  • Free EHR Demo
  • EHR
  • Practice Management
  • Medical Billing
  • Revenue Cycle
    Management
  • Patient Portal
  • Mobile EHR
  • eRx
  • Plans
  • EHR Features
  • Lab & Imaging
  • Patient Education Materials
  • Universities & Schools
  • Security Policy
  • SSO Log In
  • EHR Checklist
  • Meaningful Use
  • EPCS
  • MACRA & MIPS
  • ICD-10 Info
  • Share your Experience
  • OnPatient Portal
  • OnPatient Terms of Use
  • OnPatient Privacy Policy
  • Security Policy
  • Support Center
  • Developer API & SDK
  • EHR FAQ
  • Medical Billing Calculator
  • Medical Form Library
  • Insurance Lookup
  • ICD & HCPCS Lookup
  • App Directory
  • About Us
  • News & Updates
  • Careers
  • Contact Us
  • Testimonials
  • Logos & Branding
  • Our Flickr
  • Press
© Copyright 2019 DrChrono Inc.
  • Privacy Policy
  • Terms of Use
  • Site Map
  • twitter icon
  • facebook icon
  • youtube icon