|
Infusion:
|
KETAMINE ONLY- Medical Doctor on Site:
|
|
IV Volume:
|
KETAMINE ONLY- Diagnosis:
|
|
IV Site:
|
KETAMINE ONLY- Select All Performed:
• • •
|
|
LOT #/ EXP Date (Ketamine / Regeneron):
|
Ketamine Dose (mg)/ Patients Weight (kg)
|
|
Start & End Time (Regeneron/Ketamine IVs):
|
Complications:
|
|
Initials of IV Administered By:
|
|
|
Allergy Buster
|
Libido Boost
|
|
Antioxidant Powerhouse
|
Migrane Melter
|
|
Athletic Recovery
|
Myers Cocktail
|
|
Brain Boost (NAD)
• • •
|
Plaquex/Phosphatidylcholine
|
|
Executive Stress
|
Skin Brightening
|
|
Glutathione Dose (mg):
|
Skinny G's IV
|
|
Hangover
|
Super Immune IV
|
|
Hydrogen Peroxide
|
Total Vitamin Repletion
|
|
Inflammation Relief
|
Vitamin C
• • •
|
