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Diagnosis
Buy and Bill
First hour infusion
Additional 1 hour infusion
Additional 2 hour infusion
Additional 3 hour infusion
Additional 4 hour infusion
Additional 5 hour infusion
Additional 6 hour infusion
Additional 7 hour infusion
Additional 8 hour infusion
Additional 9 hour infusion
Additional 10 hour infusion
Hydration first hour
Hydration additional 1 hour
Hydration additional 2 hour
Hydration additional 3 hour
Hydration additional 4 hour
Hydration additional 5 hour
Hydration additional 6 hour
Hydration additional 7 hour
Hydration additional 8 hour
Hydration additional 9 hour
Hydration additional 10 hour
IV Injection
• • •
IV Push initial
IV Push 1hr add'l sequential
IV Push 2hr add'l sequential
IV Push 3hr add'l sequential
IV Push 4hr add'l sequential
IV Push 5hr add'l sequential
IV Push 6hr add'l sequential
IV Push 7hr add'l sequential
IV Push 8hr add'l sequential
IV Push 9hr add'l sequential
IV Push 10hr add'l sequential
Prolia,methotrexate injection
Rituxan MG
Rituxan vitals
Rituxan time
Rituxan Wasted
Orencia MG
Orencia vitals
Orencia time
Remicade MG
Remicade vitals
Remicade time
Remicade wasted
CYTOXAN mg
Cytoxan time
Reclast mg
Reclast time
Boniva MG
Boniva TIME
Gamunex mg
Gammagard
Actemra MG
Actemra Vitals
Actemra wasted
Prolia
Cimzia MG
Stelara
Krystexxa MG
Benlysta MG
Benlysta vitals
Flu shot (influenza)
Zofran MG
Dexamethasone/decadron
Diphenhydramine MG
Diphenhydramine po
Heparin lock 10 units
Solu-Medrol
Epinephrine 1ml
Methotrexate 50 ml
Iron sucrose
Iron Dextran
LASIK
Injection immune globin
Sodium chloride/saline
Tylenol
Comments

Infusion Form Medical Form

Rheumatologist

Infusion Form

There are 16 copies in use.
Published: Feb. 15, 2013, 10:10 a.m.
Doctor: Dr. History Physical
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