| Xylocaine |
| Exp________Date________ |
|
| Thrombin |
| Exp________Date________ |
|
| Sterile Water |
| Exp________Date________ |
|
| Peroxide |
| Exp________Date________ |
|
| Papaverine |
| Exp________Date________ |
|
|
| Methylene Blue |
| Exp________Date________ |
|
| Medication________________ |
| Strength______________ |
| Exp________Date________ |
|
| Medication________________ |
| Strength______________ |
| Exp________Date________ |
|
| Medication________________ |
| Strength______________ |
| Exp________Date________ |
|
| Marcaine |
| Exp________Date________ |
|
|