Don't forget to see our PharmaTags: Sterile Medication Labels at

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1 PharmaTags: Anaesthesia Roll Labels Order Form Toll Free: PRICING: 10 Rolls Same Medication Label=$5.75/Roll or $57.50 Box Mix and Match 10 Rolls= $6.25/Roll or $62.50/Box Minimum Order is 1 box of 10 Rolls Orders must be placed in Boxes of 10 Rolls Print this Form, mark down quantities, and fax order form to: RMAC Surgical Inc. at Large Font Strong Adhesive ASTM Compliant JCAHO Compliant Fax to Medsafety@PharmaTags.com Facility: Address: City: State/Province: Zip/Postal Code: Phone #: Fax #: Comments: Bill Us: PO # For Billing: Credit Card Type: Credit Card #: Expiration Date: Card Holder Name: Signature Don't forget to see our PharmaTags: Sterile Medication Labels at

2 MEDICATION COLOUR ITEM # QUANTITY (# of Rolls) 1% LIDOcaine 10mg/ml Grey ARL % LIDOcaine 20mg/ml Grey ARL-9108 ADENosine mg/ml White ARL-35 Adrenalin mg/ml Violet ARL-2501 ADRENALIN mcg/ml White ARL-36 Albuterol Sulfate mcg/ml White ARL-85 Alcohol % White ARL-82 ALFenta mcg/ml Orange ARL-1601 ALFentanyl mcg/ml Blue ARL-1602 Amicar mg/ml White ARL-100 Amiodarone mg/ml White ARL-83 Ancef mg/ml White ARL-37 Anectine mg/ml Flourescent Red ARL-501 Antibiotic mg/ml White ARL-62 ANTilirium mg/ml Fl. Red Stripes ARL-601 ANZEmet mg/ml White ARL-96 APRESoline mg/ml White ARL-63 ATRAcurium 10 mg/ml Red ARL-9100 ATRAcurium mg/ml Flourescent Red ARL-502 Atropine mg/ml Green ARL-32 Atropine Sulfate 1mg/ml Green ARL-9101 Atropine Sulfate mg/ml Green ARL-3201 Benadryl mg/ml White ARL-38 Betadine Solution % White ARL-84 Blank Red Stripes mg/ml Fl. Red Stripes ARL-80 Blank Violet Stripes mg/ml Violet Stripes ARL-81 Blank White White ARL-59 Blank Yellow Yellow ARL-60 Brevital 10mg/ml Yellow ARL-2301 BUPivacaine 0.25% mg/ml Grey ARL-9211 BUPivacaine 0.5% mg/ml Grey ARL-9212 BUPivacaine % Grey ARL-18 Calcium Chloride 10% White ARL-9222 Calcium Chloride mg/ml White ARL-39 Calcium Gluconate 10% White ARL-9228 CARBOcaine % Gray ARL-2001 CARDizem mg/ml White ARL-102 Cefazolin mg/ml White ARL-64 CEFOtetan mg/ml White ARL-40 Chlorpromazine mg/ml Salmon ARL-6101 CISAtracurium mg/ml Flourescent Red ARL-503 Cocaine % Gray ARL-2002 Curare mg/ml Flourescent Red ARL-504 DECadron mg/ml White ARL-41

3 Demerol mg/ml Blue ARL-11 DEXamethasone 4mg/ml White ARL-9103 Dexamethasone mg/ml White ARL-65 Dextrose % White ARL-86 Diazepam mg/ml Orange ARL-07 DILtiazem mg/ml White ARL-101 Diphenhydramine 1ml 50 mg/ml White ARL-9102 Diphenhydramine mg/ml White ARL-42 DIPrivan mg/ml Yellow ARL-2302 Dobutamine mg/ml Violet ARL-2502 DOLAsetron mg/ml White ARL-95 DOPAMINE mg/ml Violet ARL-2503 DORMicum mg/ml Orange ARL-804 Droperidol mg/ml White ARL-43 DROPeridol mg/ml Salmon ARL-6102 DURAmorph mcg/ml Blue ARL-12 EDROphonium 10 mg/ml Red Stripes ARL-9226 EDROphonium mg/ml Fl. Red Stripes ARL-602 EPHedrine 5 mg/ml Mauve ARL-9104 EPHedrine mg/ml Violet ARL-24 EPInephrine 5mcg/ml Mauve ARL-9206 EPInephrine 10mcg/ml Mauve ARL9230 EPInephrine mg/ml Violet ARL-25 EPInephrine 2.5 mcg/ml Mauve ARL-9229 ESMOlol 10mg/ml White ARL-9105 ESMOlol mcg/ml White ARL-67 ESMOlol mg/ml White ARL-66 ETOMidate 2mg/ml Yellow ARL-9200 ETOMidate mg/ml Yellow ARL-2304 FENTanyl 50mcg/ml Blue ARL-9118 FENTanyl mcg/ml Blue ARL-13 Flumazenil mg/ml Orange Stripes ARL-09 Furosemide 10mg/ml White ARL-9223 FURosemide mg/ml White ARL-68 GALLamine mg/ml Flourescent Red ARL-505 GLUCagon mg/ml White ARL-87 Glycopyrrolate mg/ml Green ARL-33 GLYCOpyrrolate 0.2 mg/ml Green ARL-9115 Heparin units/ml White ARL-44 Heparin 1000 units/ml White ARL-9224 Heparinized Saline units/ml White ARL-45 Hydralazine 20mg/ml White ARL-9207 HYDROcortisone 50 mg/ml White ARL-9205 HYDROmorphone (Dilaudid) mg/ml Blue ARL-1608 Inapsine mg/ml Salmon ARL-6103 Inderal mg/ml Violet Stripes ARL-3101 Inderal mg/ml White ARL-46 INSULin units White ARL-94 ISOproterenol mg/ml Violet ARL-26

4 Isuprel mg/ml Viloet ARL-2504 KENalog mg/ml White ARL-88 KETalar mg/ml Yellow ARL-2305 KETAmine 10mg/ml Yellow ARL-9201 KETAmine mg/ml Yellow ARL-21 KETORolac 30mg/ml White ARL-9106 KETORolac mg/ml white ARL-98 Labetalol 5mg/ml Mauve Stripes ARL-9107 Labetalol mg/ml Violet Stripes ARL-29 LASIX mg/ml White ARL-47 Levallorphan mg/ml Blue Stripes ARL-1603 LEVOphed mg/ml Violet ARL-2505 LIDOcaine % Grey ARL-19 Lidocaine 1% Bupivacaine 0.25% Grey ARL-97 LORazepam mg/ml Orange ARL-801 Magnesium Sulfate g/ml White ARL-48 MANNitol mg/ml White ARL-49 MARCaine % Grey ARL-20 Meperidine mg/ml Blue ARL-1604 MEPivacaine 1% ml Grey ARL-9213 MEPivacaine 1.5% ml Grey ARL-9215 MEPivacaine 2% ml Grey ARL-9214 METHergin mcg/ml White ARL-93 METHergine 0.2mg/ml White ARL-9203 METHOhexital mg/ml Yellow ARL-22 Methylprednisolone mg/ml White ARL-50 Metoclopramide 5mg/ml White ARL-9110 Metoclopramide mg/ml White ARL-51 Metocurine mg/ml Flourescent Red ARL-506 METOprolol 1mg/ml White ARL-9208 METOprolol mg/ml White ARL-89 MIDazolam 1mg/ml Orange ARL-9120 Midazolam mg/ml Orange ARL-08 MIVAcron mg/ml Fl. Red Stripes ARL-603 MIVAcurium mg/ml Flourescent Red ARL-507 Morphine 1mg/ml Blue ARL-9218 Morphine mg/ml Blue ARL-14 Morphine Sulfate mg/ml Blue ARL-1401 Naloxone 40mcg/ml Blue Stripes ARL-9227 Naloxone mg/ml Blue Stripes ARL-1701 Narcan mg/ml Blue Stripes ARL-17 Narcan Naloxone 0.4 mg/1ml Blue Stripes ARL-9111 NAROpin mg/ml Gray ARL-2003 NEOstigmine 1mg/ml Red Stripes ARL-9112 NEOstigmine mg/ml Florescent Red Stripes ARL-06 Neosynephrine mg/ml Violet ARL-2506 NESAcaine % Gray ARL-2004 NIMBex mg/ml Fl Red Stripes ARL-604 Nipride mcg/ml Violet Stripes ARL-30

5 Nisentil mg/ml Fl. Red Stripes ARL-605 Nitroglycerine mcg/ml Violet Stripes ARL-31 Nitroprusside mcg/ml Violet Strips ARL-3102 Nocuron mg/cc Flourescent Red ARL-508 NORcuron mg/ml Flourescent Red ARL-509 NORepinephrine mcg/ml Violet ARL-27 NORMAL Saline 0.9% White ARL-52 Normal Saline Flush White ARL9231 Normodyne mg/ml White ARL-70 Nubain mg/ml Blue ARL-1605 OMNIpaque mgi/ml White ARL-9001 ONDansetron 2mg/ml White ARL-9121 Ondansetron mg/ml White ARL-99 Oxytocin 10 units/ml White ARL-9204 Oxytocin units White ARL-71 PANCuronium mg/ml Florescent Red ARL-02 Papaverine mg/ml White ARL-72 Pavulon mg/ml Flourescent Red ARL-510 PENTObarbital Yellow ARL-2306 PENTothal % Yellow ARL-23 PETHidine White ARL-103 PHENergan mg/ml White ARL-90 PHENTolamine mg/ml Violet Stripes ARL-3104 Phenylephrine 1% 10mcg/ml Mauve ARL-9113 Phenylephrine mcg/ml Violet ARL-28 PIPEcuronium mg/ml Florescent Red ARL-03 PITocin units/ml White ARL-73 PROcaine mg/ml Gray ARL-2005 Promethazine mg/ml White ARL-53 Propofol 10mg/ml Yellow ARL-9114 Propofol mg/ml Yellow ARL-2307 Prostigmine mg/ml Fl. Red Stripes ARL-606 PROTAMINE mg/ml White ARL-54 PYRIDostigmine mg/ml Fl. Red Stripes ARL-607 RANitidine mg/ml White ARL-55 Reglan mg/ml White ARL-74 Regonol mg/ml Fl. Red Stripes ARL-608 REMIfentanil 50mcg/ml Blue ARL-9220 REMifentanil mcg/ml Blue ARL-15 Robinul mg/ml Green ARL-3401 ROCuronium mg/ml Florescent Red ARL-01 ROCuronium 10mg/ml Red ARL-9209 Romazicon mg/ml Orange Stripes ARL-10 ROPIVAcaine 0.2% ml Grey ARL-9216 ROPIVAcaine 0.5% ml Grey ARL-9217 ROPIVAcaine % Gray ARL-2006 Scopolamine 0.4 mg/ml Green ARL-9225 Scopolamine mg/ml Green ARL-34 SENSORcaine % Gray ARL-2007

6 Sodium Bicarbonate % White ARL-75 Sodium Chloride % White ARL-76 SoluMedrol mg/ml White ARL-77 Stemetil White ARL-104 STERILE Water White ARL-91 Sterile Water 20 ml White ARL-9117 Sublimaze mcg/ml Blue ARL-5601 Sublimaze mcg/ml White ARL-56 SUCcinylcholine 20mg/ml Red ARL-9119 SUCcinylcholine mg/ml Florescent Red ARL-04 SUFenta mcg/ml Blue ARL-1606 SUFentanil 50mcg/ml Blue ARL-9221 SUFentanil mcg/ml Blue ARL-16 SYNTOCIN mg/ml White ARL-57 Tensilon % Fl. Red Stripes ARL-609 Thiamylal 2.5% Yellow ARL-2308 Thiopental 25mg/ml Yellow ARL-9202 Thiopental 2.5% Violet ARL-2309 TORAdol mg/ml White ARL-78 TRAcrium mg/ml Flourescent Red ARL-511 TRIAMcinolone Acetonide mg/ml White ARL-8801 Trimethaphan mg/ml Violet Stripes ARL-3103 TUBOcuraine mg/ml Flourescent Red ARL-512 Ultiva mcg/ml Blue ARL-1607 Valium mg/ml Orange ARL-802 VASOpressin units/ml Violet ARL-2507 VECuronium 1mg/ml Red ARL-9210 VECuronium mg/ml Flourescent Red ARL-05 VERAPamil mg/ml White ARL-58 Versed mg/ml Orange ARL-803 VISIpaque mgi/ml White ARL-92 XYLOcaine % Gray ARL-2008 Zemuron mg/ml Flourescent Red ARL-513 Zofran mg/ml White ARL % Sodium Chloride 20 ml White ARL-9116

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