THE CENTER FOR FUNCTIONAL GENOMICS AND MIND-BODY MEDICINE PROGRESS NOTE

NAME:__________________________________________DATE:_______________DOB:_______

VITALS: B/P:__________ PULSE:__________ RESP:_____ HT:________ WT:___________

KETAMINE INFUSION

DOSE:_________________________

LOT #_________________________

EXP:__________________________

IV SITE: ____________________

START:________________________

END:__________________________

POST B/P: ____________________

DYSPHORIA: ___________________

SIDE EFFECTS:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________