Patient-..............

Patient- ..............
EPIDURAL BLOCK
EPIDURAL BLOCK
Spinal Needle # 23 2
Kenacort 40 2 Spinal Needle # 23 2
Omnipaque die 1 Kenacort 40 2
NS 25 ml 1 Omnipaque die 1
Anawin 0.25% 1 NS 25 ml 1
Lox 2% 1 Vial Anawin 0.25% 1
D/Needle 24 2 Lox 2% 1 Vial
D/Gloves 6.5 2 D/Needle 24 2
D/Syringe 10,5 ml 2each Luerlock D/Gloves 6.5 2
Hylase 1 D/Syringe 10,5 ml 2 each Luerlock
Hand Rub 1 Hylase 1
Hand Rub 1

Patient-..............
Patient- ..............
EPIDURAL BLOCK
EPIDURAL BLOCK
Spinal Needle # 23 2
Kenacort 40 2 Spinal Needle # 23 2
Omnipaque die 1 Kenacort 40 2
NS 25 ml 1 Omnipaque die 1
Anawin 0.25% 1 NS 25 ml 1
Lox 2% 1 Vial Anawin 0.25% 1
D/Needle 24 2 Lox 2% 1 Vial
D/Gloves 6.5 2 D/Needle 24 2
D/Syringe 10,5 ml 2 each Luerlock D/Gloves 6.5 2
Hylase 1 D/Syringe 10,5 ml 2 each Luerlock
Hand Rub 1 Hylase 1
Hand Rub 1
 PAIN CLINIC
PAIN CLINIC

Patient’s Name-
Patient’s Name-
Age/Sex -
Age/Sex -
Procedure done –
Procedure done –
Reffered By-
Reffered By-
O.T. Charges –
O.T. Charges –
Procedure Charges –
Procedure Charges –

Total –
Total -

PAIN CLINIC
PAIN CLINIC

Patient’s Name-
Patient’s Name-
Age/Sex -
Age/Sex -
Procedure done –
Procedure done –
Reffered By-
Reffered By-
O.T. Charges –
O.T. Charges –
Procedure Charges –
Procedure Charges –

Total -
Total -