|
Testosterone Injection
|
|
|
Medication
|
Strength
|
|
Dosage
|
(Enter dosage if not on drop down)
|
|
LOT#
|
Expiration
|
|
Manufacturer
|
Route
|
|
Injection Site
|
|
|
Given By
|
Was Testo supplied by patient?
|
|
Summary
• • •
|
|
|
|
|
|
Gonadorelin Injection
|
|
|
Medication
|
Strength
|
|
Dosage
|
Lot #
|
|
Manufacturer
|
Expiration
|
|
Injection Site
|
Route
|
|
Given By
|
Was G supplied by patient?
|
|
Summary
• • •
|
|
|
Vitamin Injection
|
|
|
Medication
• • •
|
Strength
• • •
|
|
Dosage
|
Lot #
|
|
Manufacturer
|
Expiration
|
|
Route
|
Injection Site
|
|
Given By
|
Summary
• • •
|
|
Injection Demo
|
|
|
Chief Complaint
|
Subject
• • •
|
|
Testosterone Demo
|
|
|
Gonadorelin Demo
|
|
|
Plan
• • •
|
|
|
Medication Refill
|
|
|
Medication
|
Strength
|
|
Dosage
|
(Enter dosage if not on drop down)
|
|
Prefilled Quantity
|
LOT#
|
|
Expiration
|
Manufacturer
|
|
|
Dispensed By:
|
