| Xylocaine |
| Exp________Date________ |
|
| Tobradex |
| Exp________Date________ |
|
| Thrombin |
| Exp________Date________ |
|
| Sterile Water |
| Exp________Date________ |
|
| Peridex |
| Exp________Date________ |
|
|
| NaCL |
| Exp________Date________ |
|
| Mineral Oil |
| Exp________Date________ |
|
| Medication________________ |
| Strength______________ |
| Exp________Date________ |
|
| Medication________________ |
| Strength______________ |
| Exp________Date________ |
|
| Medication________________ |
| Strength______________ |
| Exp________Date________ |
|
|