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. Acetazolamide UD Tablets 250mg  Par = 12

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* 5. Akwa Tears lubricant ophthalmic ointment 3.5g tube  Par = 12

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* 6. Apraclonidine 0.5% ophthalmic solution 5ml bottle  Par = 1

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* 7. Cyclopentolate 1% (Cyclogyl) ophthalmic solution 2ml bottle  Par = 4

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* 8. Dorzolamide 2% ophthalmic solution 5mL bottle  Par = 2

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* 9. Dorzolamide/Timolol 2%/0.5% (Cosopt) ophthalmic solution unit dose droppers Par = 15

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* 10. Erythromycin 0.5% ophthalmic ointment 1g tube  Par = 2

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* 11. Fluorescein Sodium ophthalmic Strips  Par = 1 box

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* 12. Fluorescein/Benoxinate 0.25%/0.4% (Altafluor Benox) ophthalmic solution (refrigerated) 5ml bottle  Par = 6

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* 13. Latanoprost 0.005% ophthalmic solution (refrigerated) 2.5ml bottle  Par = 1

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* 14. Moxifloxacin 0.5% (Vigamox) ophthalmic solution 3ml bottle Par = 1

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* 15. Olopatadine HCL 0.1% (Patanol) ophthalmic solution 5ml bottle  Par = 1

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* 16. Phenylephrine HCL 2.5% ophthalmic solution (refrigerated) 2mL bottle  Par = 6

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* 17. Pilocarpine HCL 2% ophthalmic solution 15ml bottle  Par = 1

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* 18. Prednisolone Acetate 1% ophthalmic suspension 5ml bottle  Par = 1

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* 19. Proparacaine HCL 0.5% ophthalmic solution 15ml bottle  Par = 6

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* 20. Refresh Celluvisc lubricant eye drops 30 0.4ml ampules  Par = 1 box

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* 21. Teargen II lubricant eye drops 15ml bottle  Par = 12

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* 22. Timolol Maleate 0.5% ophthalmic gel forming solution 5ml bottle  Par = 1

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* 23. Tobramycin/Dexamethasone 0.3% (Tobradex) ophthalmic solution 2.5mL bottle  Par = 1

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* 24. Tobramycin/Dexamethasone 0.3% (Tobradex) ophthalmic ointment 3.5g tube  Par = 1

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* 25. Tropicamide 1% (Mydriacyl) ophthalmic solution 3mL bottle  Par = 6

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