Medic 1 Drug Date Check Sheet
Medic 1 Jump Bag
Aspirin
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Tylenol Oral
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Tylenol Oral
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ibuprofen Oral
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Atropine
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Atropine
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Atropine
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Narcan
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Narcan
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Nitroglycerin
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Glucagon
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Haldol
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Zofran IV
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Zofran IV
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Zofran ODT
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Zofran ODT
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phenergan
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phenergan
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Amiodarone
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Amiodarone
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Amiodarone
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Labetalol
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Magnesium
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Magnesium
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Adenosine 6 mg
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Adenosine 12 mg
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Adenosine 12 mg
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Calcium Gluconate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Calcium Gluconate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Solumedrol
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Solumedrol
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Epi 1:1
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Epi 1:1
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Epi 1:1
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Epi 1:10
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Epi 1:10
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Benadryl
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Benadryl
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Benadryl
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Albuterol
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Albuterol
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Albuterol
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Afrin Nasal Spray
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Lidocaine
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Lidocaine
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Norepinephrine
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Sodium Bicarb
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
D5W
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
D10
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NaCL 1000 ml
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NaCL 250 ml
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Tylenol Suppositories (In Cooler)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Tylenol Suppositories (In Cooler)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cardizem (In Cooler)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Narcotic Bag Medic 1
Ketamine 500 mg
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ketamine 500 mg
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ativan
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ketorolac
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phenergan
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rocephin
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rocephin
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
TXA
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
TXA
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Etomidate
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rocuronium
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rocuronium
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Vecuronium
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Valium
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Versed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fentanyl
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fentanyl
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Morphine
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
Glidescope Charged?
*
Yes
No
LUCAS Charged?
*
Yes
No
Missing Items/Problems
Submit
Should be Empty: