Psychiatry & Psychology
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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:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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