standard operating procedure college station fire department
standard operating procedure college station fire department
standard operating procedure college station fire department
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SUBJECT: Medication Exchange and Replacement SOP: 400.3.10<br />
CATEGORY: EMS Procedures PAGE: 4 of 4<br />
College Station Fire Department<br />
Emergency Medical Service<br />
Controlled Drug Usage Form<br />
Call Number: ________________________<br />
Date: _____________________________<br />
Time: ______________________<br />
Name of Patient:<br />
_______________________________________________________________________<br />
Name of Drug: Versed Morphine Nubain (Circle One)<br />
How Ordered: Protocol Physician's Order (Circle One)<br />
Amount Administered: __________________________<br />
Amount Destroyed: ________________________<br />
___________________________________<br />
Witness:<br />
Paramedic Signature:<br />
____________________________________________________________________<br />
Physician Signature:<br />
____________________________________________________________________<br />
(Only if given by direct orders of this Physician)<br />
• • • • • • •<br />
White: Call Report Yellow: Medical Director Pink: Hospital<br />
rev:9/94, 8/95, 4/98, 3/99, 3/02,re#’d 11-02