|
IV Title
|
|
|
Procedure Selected
• • •
|
Medications Add Ons
• • •
|
|
IV Placement
• • •
|
Bag Size
|
|
Administered By
|
Payment
|
|
First Time IV
|
Complications
• • •
|
|
Successful Procedure
|
Program Number
|
|
Base Bag
|
Energy
|
|
Immunity
|
NAD
|
|
Beauty
|
Detox
|
|
PostOp
|
Liquid Money
|
|
Additional Notes
|
|
