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Ozone Therapy Treatment
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Activate Patient Demographics:
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Ozone Type
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Length Of Procedure (# in min)
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Patient's Blood (mL): Normal 200mL
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Normal Saline (mL): Normal 500mL
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Heparin (units): Normal 1,000 units
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Ozone Gas (mL): Normal 200mL
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Gamma
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Select Size of 2nd Bag of NS:
• • •
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Additional IV Nutrients Added:
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Vitamin B-Complex* - 1 mL
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Vitamin C (Ascorbic Acid) (500 mg/mL) - 3 mL
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Vitamin B-5 (Dexpanthenol) (250 mg/mL) - 1 mL
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Vitamin B-6 (Pyridoxide) (100 mg/mL) - 1 mL
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Vitamin B12 (Methylcobalamin) (5mg/mL)- 1mL
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Magnesium Sulfate (500 mg/mL) - 2 mL
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Taurine (50 mg/mL) - 1 mL
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Amino Blend* - 3 mL
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Banana Bag (Infuvite*) - 10 mL
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Tri-Immune Boost (Glutathione 200mg/mL, Ascorbic Acid 200mg/mL, and Zinc Sulfate 2.5mg/mL
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Additional Nutrient via IV Bag:
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# mL
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Additional IV Push Given:
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Glutathione (200 mg/mL) - 3 mL
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Pepcid (Famotidine) (10 mg/mL) - 2 mL
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Reglan (Metoclopramide) (5 mg/mL) - 2 mL
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Toradol (Ketrorolac) (30 mg/mL) - 1 mL
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Zofran (Ondansetron) (2 mg/mL) - 2 mL
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Select Site of IV:
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Other IV Site (if applicable):
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Enter Number of Attempts:
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Select Angiocath Size:
• • •
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Standard Procedure Note
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Reference Guide for Dosing and Frequency
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Follow Up Appointment Recommendation (days/weeks)
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Enter Ending HR:
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Enter Ending BP:
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Enter Complications:
• • •
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Enter Custom Note:
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Sign Informed Consent for IV Therapy:
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Signed Informed Consent for Ozone Therapy
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