Form:LPC Inventory CHECKLIST.html,LPC Inventory CHECKLIST_Viewer.html
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Subject: LPC Inventory CHECKLIST,
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DEPARTMENT OF HEALTH SERVICES COUNTY OF LOS ANGELES
REFERENCE NO. 1106.1
SUBJECT: LPC INVENTORY AND CHECKLIST FOR ITEMS DEPLOYED
RECEIVING FACILITY:
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ITEM Quantity On Hand Number Checked Out
Adenosine Injection (6mg/vial) [ ] [ ]
Albuterol Inhaler (20mg/inhaler) [ ] [ ]
Albuterol Oral Inhalation Solution (2.5mg/3ml/dose) [ ] [ ]
Amiodarone Injection (50mg/ampule) [ ] [ ]
Atropine Injection (0.4mg/ml) 20ml multi-dose vial [ ] [ ]
Calcium Chloride 10% Injection (1gm/10ml) Pre-Filled Syringe [ ] [ ]
Cefazolin Injection (1gm/vial) [ ] [ ]
Cephalexin Tablet (500mg/tablet) [ ] [ ]
Ciprofloxacin Capsule (500mg/capsule) [ ] [ ]
Diphtheria-Tetanus (Td) Adsorbed Dose Injection (0.5ml/dose) - Adult [ ] [ ]
Diphtheria-Tetanus Toxoid (DT) Injection (0.5ml/dose) - Peds [ ] [ ]
Dextrose 50% Injection (50ml syringe) [ ] [ ]
Diphenhydramine Injection (50mg/ml vial) [ ] [ ]
Dopamine Injection (200mg/vial) [ ] [ ]
Doxycycline Capsules (100mg/tablet) [ ] [ ]
Epinephrine Injection 1:1,000 (1mg/ml/ampule) [ ] [ ]
Epinephrine Injection 1:1,000 30ml vial [ ] [ ]
Epinephrine Injection 1:10,000 (1mg/10ml) Pre-Filled Syringe [ ] [ ]
Glucagon Injection (1mg/vial) [ ] [ ]
Haloperidol Injection (5mg/vial) [ ] [ ]
Haloperidol Tablet (5mg/tablet) [ ] [ ]
Insulin Regular Injection (100units/ml - 10ml vial) [ ] [ ]
Lactated Ringers Solution Injection (1000ml/bag) [ ] [ ]
Lidocaine Injection 2% (10mg/ml) Pre-Filled Syringe [ ] [ ]
Lidocaine Injection 1% (20ml/vial) [ ] [ ]
Magnesium Sulfate Injection (1gm/2ml) [ ] [ ]
Naloxone Injection (2mg/vial) [ ] [ ]
Nitroglycerin Tablets or Spray (0.4mg/tablet or spray - 100 doses) [ ] [ ]
Ondansetron Injection (2mg/vial) [ ] [ ]
Polymyxin Bacitracin Ointment (0.9gm/packet) [ ] [ ]
Potassium Chloride Injection (40mEQ/20ml) [ ] [ ]
Sodium Bicarbonate Injection (44.6mEQ/50 ml) Pre-Filled Syringe [ ] [ ]
Sodium Chloride 0.9% Injection (100ml/bag) [ ] [ ]
Sodium Chloride 0.9% Injection (1000ml/bag) [ ] [ ]
Sodium Polystyrene- Oral Powder (454gm/container) [ ] [ ]
Tetracaine Hydrochloride Ophthalmic Solution 0.5% (2ml/bottle) or Proparacaine Hydrochloride Ophthalmic Solution 0.5% (15ml/bottle) [ ] [ ]
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Comments/Notes
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Released by:
Date released:
Received by:
Facility:
Returned by:
Date returned:
Returned Items received by:
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Express Sending Station:
Senders Express Version:
Senders Template Version: