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MAX QTY ON

DANGEROUS DRUGS REQUISITION


FORM
 MIDAZOLAM (DORMICUM) 10
5MG/5ML AMPULE
 MIDAZOLAM (MIDAZOLEX) 10
5MG/5ML AMPULE
 DIAZEPAM (VALIUM) 3
10MG/ML AMPULE
 EPHEDRINE SULFATE 3
50MG/ML AMPULE
 FENTANYL CITRATE 3
100MCG/2ML AMPULE
 FENTANYL CITRATE 3
(SUBLIMAZE) 100MCG/2ML
AMPULE
 NALBUPHINE HCL (NUBAIN) 4
10MG/ML AMPULE
 NALBUPHINE HCL (ENDURPIN) 4
10MG/ML AMPULE
 PETHIDINE HCL (DEMEROL) 3
100MG/2ML AMPULE
 PHENOBARBITAL SODIUM 3
(LUMINAL) 130MG/ML
AMPULE
 MORPHINE SULFATE 3
10MG/ML AMPULE
 MORPHINE SULFATE 3
16MG/ML AMPULE
 KETAMINE HCL 50MG/ML 1 1 VIAL
VIAL= 10ML (50MG PER CC)

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