Drug Order Details

Identify the person placing the order and then enter the current quantity on hand for all items.

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* 1. Ordering Location

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* 2. Name of person completing order

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* 3. Contact number for person completing order

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* 4. 2oz (60ml) Amber Plastic Bottle w/Cap  Par = 12

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* 5. 6oz (180ml) Amber Plastic Bottle w/Cap Par = 12

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* 6. 12oz (360ml) Amber Plastic Bottle w/Cap Par = 12

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* 7. 9 Dram Amber Plastic Vial w/Cap Par = 12

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* 8. 13 Dram Amber Plastic Vial w/Cap Par = 12

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* 9. Fluorescein Sodium Ophthalmic Strip  Par = 15

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