Spravato Administration

Pt was administered 
[select name="variable_1" value="24 mg|56 mg|82 mg"] of esketamine via intranasal insufflation in clinic today under my direct medical supervision.  
Esketamine administration was observed by :
[text name="variable_1" default="sample text"]
Initial BP:
[text name="variable_1" default="sample text"]
BP at 40 min post administration:
[text name="variable_1" default="sample text"]
BP at discharge from clinic:
[text name="variable_1" default="sample text"]

Time Treatment Started:
BP at discharge from clinic:
[text name="variable_1" default="sample text"]
Time Treatment Ended:
BP at discharge from clinic:
[text name="variable_1" default="sample text"]
Time pt was ready to leave:
BP at discharge from clinic:
[text name="variable_1" default="sample text"]

Pt experienced dissociation:
[checkbox name="variable_1" value="yes|no"]




Pt experienced sedation:
[checkbox name="variable_1" value="yes|no"]

Pt experienced SAE:
[checkbox name="variable_1" value="yes|no"]



Pt left the clinic stable after treatment and with a ride:
[checkbox name="variable_1" value="yes|no"]
Pt was administered
of esketamine via intranasal insufflation in clinic today under my direct medical supervision.
Esketamine administration was observed by :

Initial BP:

BP at 40 min post administration:

BP at discharge from clinic:


Time Treatment Started:
BP at discharge from clinic:

Time Treatment Ended:
BP at discharge from clinic:

Time pt was ready to leave:
BP at discharge from clinic:


Pt experienced dissociation:





Pt experienced sedation:


Pt experienced SAE:




Pt left the clinic stable after treatment and with a ride:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.42, 12 form elements, 80 boilerplate words, 7 text boxes, 4 checkboxes, 1 drop downs, 16 total clicks
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