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Ambulance 2 Narcotic Tracking Sign Off
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* Indicates required question
Paramedic (First name, Last Name)
*
Your answer
A2 Narcotic Box Tag 1 Left Side
*
Your answer
A2 Narcotic Box Tag 1 Right Side
*
Your answer
A2 Narcotic Box Tags Color
*
Green
Yellow
Other:
A2 Narcotic Box Expiration Date
*
MM
/
DD
/
YYYY
Fentanyl Count 100mcg/2mL
*
Zero
One
Two
Three
Four
Five
Versed Count 5mg/1mL
*
Zero
One
Two
Three
Four
Five
Hydromorphone Count 2mg/1mL
*
Zero
One
Two
Three
Ketamine Count 500mg/10mL
*
Zero
One
Ketamine Count 50mg/5mL
*
Zero
One
Two
Please Note Any Abnormalities
Your answer
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