Kevin stasney m
Physician:_______________________________
City____________________ State____ Zip_______ Okatie, SC 29936
Phone_________________ Fax________________
Phone: (888)-322-6641
FAX: (843)-645-9987
Patient Name: ______________________________
Date: ___________________
Address: _ __________________________________
City: ____________________
State: _______
Zip Code: _______
Date of Birth: _______________________________
Allergies: ________________
Telephone Number: _________________________
Nausea/Vomiting/Agitation
Lorazepam 1 mg/mL/Diphenhydramine 12.5 mg/mL/Haloperidol
Ondansetron 4 mg/0.1 mL Topical Lipoderm Ginger Root 200 mg capsules
ABHR (Lorazepam/Diphenhydramine/Haldol/Metoclopromide) Lorazepam gel (1mg/ml)
Sig: _____________________________________________________________________________________ Quantity: _________
________________________________________________________________________________________________________________________________
Dry Mouth
Sodium Cl 8.8 mg/Potassium Cl 3.1 mg/Calcium Cl 3.4 mg Base A Troche
Sig: ________________________________________________________________________________________
________________________________________________________________________________________________________________________________ Mouth Pain
Misoprostol 0.0024%/Diphengydramine HCl 0.1%/Compound Oral Rinse
Morphine Sulfate 1 mg/mL Oral Gel Diphenhydramine HCl 25 mg/Lidocaine HCl 2%/Hydrocortisone 1%
Magic Mouthwash (Tetracycline/Diphenhydramine/Lidocaine/Maalox)* *( You can customize your own mouthwash)
Sig: _____________________________________________________________________________________ Quantity: _________
________________________________________________________________________________________________________________________________
Pain Managment Ketoprofen 10% Topical Lipoderm
Ketamine 10%/Gabapentin 6%/Clonidine 0.2%/Nifedipine 2% Topical Lipoderm Diclofenac Sodium 10% Lipoderm Transdermal Gel
Ketamine 10%/Gabapentin 6%/Clonidine 0.2%/Nifedipine 2% Topical Lipoderm* *(Ideal for Neuropathic pain)
Sig: _____________________________________________________________________________________ Quantity: _________
________________________________________________________________________________________________________________________________
Wound Care Managment Phenytoin 5%/Misoprostol 0.0024% Topical Gel
Phenytoin 2%/Misoprostol 0.0024%/Lidocaine 2%/Bupivacaine 0.2%/Diphenhydramine Ketoprofen 2%/Lidocaine 2%/Misoprostol 0.0024%/Phenytoin 2%/Aloe Vera 0.2%
Misoprostol 0.0024%/Phenytoin 5%/Metronidazole 2% Topical Gel
Sig: _____________________________________________________________________________________ Quantity: _________
________________________________________________________________________________________________________________________________
Physician Signature: ____________________________
Source: http://www.lowcountryrx.com/wp-content/uploads/2010/10/NauseaPainWound.pdf
Chabad of Bradenton & Lakewood Ranch This year more people will experience the joy of Purim! Purim is one of the most joyous and fun holidays on the Jewish calendar. On Purim, we emphasize the importance of Jewish unity and friendship by sending gifts of food to friends and family. This Purim mitzvah is called Mishloach Manot. This year Chabad is sponsoring shared Mishloach Manot gift boxes
Sifton Bog White-tailed Deer Issue Steering Committee Meeting Notes Tuesday, July 10, 2001, Riverside United Church Committee member attendance: Barry UTRCA, City of London and Ontario Ministry of Natural Resources Representatives: Joe DeLaronde Welcome & Introductions The members of the committee introduced themselves. Teresa explained that the meeting would beinformal and that
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