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Pre-Treatment
|
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Are Consents Signed?
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Sulfa Allergy?
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Previous Complications?
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Complications Experienced
• • •
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Additional Comments:
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Vitamin Injection
|
|
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Injection Type:
• • •
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Quantity
• • •
|
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Area
|
Intramuscular or Subcutaneous?
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Comments:
|
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Injection Type:
• • •
|
Quantity
• • •
|
|
Area
|
Intramuscular or Subcutaneous?
|
|
Comments:
|
|
|
Injection Type:
• • •
|
Quantity
• • •
|
|
Area
|
Intramuscular or Subcutaneous?
|
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Comments:
|
|
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Medical Weight Loss:
|
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Weigh In Sheet
|
Injection #:
|
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Provider's Signature
|
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Administering Staff Signature:
• • •
|
Attending:
• • •
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