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. Aloe Vera 100% gel 170gm tube  Par = 3

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* 5. Bacitracin zinc 500 units/gm ointment 1gm packets, 1 box  Par = 1

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* 6. Bacitracin zinc 500 units/gm ointment 30gm tube  Par = 3

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* 7. Calmoseptine ointment 3.5gm packets, 1 box  Par = 2

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* 8. Calmoseptine ointment 113gm tube  Par = 1

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* 9. Capsaicin 0.025% cream 60gm tube  Par = 3

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* 10. Cavalon durable barrier cream 92gm  tube  Par = 2

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* 11. Cavilon extra dry skin cream 118ml tube  Par = 3

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* 12. Chlorhexidene gluconate 4% solution 118ml bottle  Par = 3

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* 13. Collagenase 250units/gm ointment (Santyl) 30gm tube  Par = 3

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* 14. DuoDerm hydroactive Gel 30gm tube (Par 3 = 1 box of 3 tubes) Par = 3

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* 15. Lubriderm daily lotion 473ml pump bottle  Par = 3

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* 16. Petrolatum 41% ointment (Aquaphor) 50gm tube  Par = 3

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* 17. Petrolatum 41% ointment (Aquaphor) 85gm tube  Par = 3

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* 18. Petrolatum 41% ointment (Aquaphor) 396gm tub  Par = 3

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* 19. Silver nitrate applicators single use 10/packet Par = 1

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* 20. Silver sulfadiazene 1% cream 400gm tub  Par = 1

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* 21. Silver sulfadiazene 1% cream 50gm tube  Par = 2

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* 22. Sodium chloride 0.9% flush syringe 10ml 30 per box  Par = 2

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* 23. Zinc oxide 20% ointment 30gm tube  Par = 2

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* 24. Zinc gelatin impregnated (Gelocast) unna boot  Par = 2

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