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Narcotics Check-Off
Narcotics Check Off
Narcotics Check Off
If you are human, leave this field blank.
Narcotics Check Off
Oncoming Medic / Paramedic #1
*
Patient Care Provider (First and Last Name REQUIRED!!!)
Driver/Operator Name
*
Driver/Operator Name
Shift Location
*
Beaumont
Baytown
San Antonio
The Woodlands
Cypress/Katy
Houston
Corpus Christi
Clear Lake/ Webster
Kingwood
Dallas
Stephenville
Kingwood
Longview
College Station
Round Rock
New Braunfels
Unit Number
*
M-101
M-102
M-103
M-104
M-105
M-106
M-107
M-108
M-109
M-110
M-111
M-112
M-113
M-114
M-115
M-116
M-117
M-118
M-119
New Option
Vehicle Number
*
M-101
M-102
M-103
M-104
M-105
M-106
M-107
M-108
M-109
M-110
M-111
M-112
M-113
M-114
M-115
M-116
M-117
M-118
M-119
Time
Date
Versed (Count)
*
Please insert the Versed count here. Versed is only to be stored in the narcotics lock box.
Relieved Medic / Paramedic #2
*
Who was the previous Paramedic on shift? Please Type their First and Last Name Above
Signature
*
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Please sign using a stylus or finger on any touch screen device.
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