Date Patient. No.

Patient's Name Patient's INP Physician's Name

 CPU Preparation L

Diagnostic TPP Start Time End Time Signature

 CPU Preparation Log Form

Drugs, diluents and acc

Prescription
Drug Batch No. Qty
 Drugs, diluents and accessories used
Remaining Qty Protector Injector Serum Remaining Qty
0 0
 Surplus Pharmacist
Surplus
Qty Review

PHA-Trial
May-22
Physican Name TTP
Dany Gholam Army
Elie Bechara COOP
Georges Hachem INS
Joseph Makdessi MOH
Mirna Hajj N+I
Mounir Khoury N+P
Nabil Chamseddine NSSF
Peter Noun N+Self
Sec
Self
Sec+Self
Serums
Dextrose In Water 5% 50 cc
Dextrose In Water 5% 100 cc
Dextrose In Water 5% 250cc
Dextrose In Water 5% 250cc (NPVC)
Dextrose In Water 5% 500cc
Dextrose In Water 5% 500cc (NPVC)
Dextrose In Water 5% 1000cc
Sodium Chloride 0.45% 500cc
Sodium Chloride 0.9% 50cc
Sodium Chloride 0.9% 100cc
Sodium Chloride 0.9% 250cc
Sodium Chloride 0.9% 250cc (NPVC)
Sodium Chloride 0.9% 500cc
Sodium Chloride 0.9% 500cc (NPVC)
Sodium Chloride 0.9% 1000cc
Baxter 2 Days