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About
The Team
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Our Services
Event Request
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Infusion Information
Registration / Consent
Anytime Fitness Infusion Clinics
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Client Documentation
Last name
First name
Date of Service
DOB
Registration / Consent Verified
*
Yes
No
IV Initiation
Catheter Size
Number of Attempts
Initiated by
Interventions
*
Required
Right
Left
AC
Forearm
Other, See Team Documentation
Interventions
*
Required
Site cleaned, catheter secured, transparent dressing, and bleeding controlled
Other, see team documentation
Fluid Administration
Intravenous Fluid
Choose an option
Start Time
End Time
Discontinuation / Disposition
Inteventions
*
Required
Catheter removed, tip intact, bleeding controlled, client educated
No Complications
Other, see team documentation
Disposition
*
Required
Client awake, alert, ambulates safely and returns to event
Sent for medical evaluation, see team documentation
Other, see team documentation
Team Documentation
Notes
Team Member
Submit Documentation
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