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<center><img src="**IMAGE SRC**" width="98" height="122"></img>
<h1>Unit Controlled Substance Log</h1></center>

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<td colspan="3" style="background:white; padding:.75pt .75pt .75pt .75pt"><br>
<br>
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<td colspan="4" align="left"><strong>
<li style="display:inline"><em>Unit : </strong>M116</em></li></td>
</tr>
<tr>
<td colspan="4" align="left"><strong>
<li style="display:inline"><em>Date &amp; Time : </strong>1/5/2020, 8:10 AM CST </em>
</li></td>
</tr>
<tr>
<td colspan="4" align="left"><strong>
<li style="display:inline"><em>Current Unit Condition</em></strong></li></td>
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<tr>
<td colspan="4" align="left"><strong>
<hr>
</strong></td>
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<tr>
<td colspan="2" align="left"><strong><em>Question</em></strong><br>
</td>
<td align="left"><strong><em>Answer</em></strong></td>
<td align="left"><strong><em>Comments</em></strong></td>
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<hr>
</strong></td>
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<td align="left" colspan="2">Witness Name</td>
<td align="left">Post, Matt</td>
<td align="left"></td>
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<td align="left" colspan="2">Are there any changes from the previous submission?</td>
<td align="left">No</td>
<td align="left"></td>
</tr>
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<td align="left" colspan="2">Was a medication used since last submission?</td>
<td align="left">No</td>
<td align="left"></td>
</tr>
<tr>
<td align="left" colspan="2">Fentanyl Concentration</td>
<td align="left">100mcg/mL</td>
<td align="left"></td>
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<td align="left" colspan="2">Fentanyl #1 Control Number</td>
<td align="left">049323-N</td>
<td align="left"></td>
</tr>
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<td align="left" colspan="2">Fentanyl #1 Expiration Date</td>
<td align="left">04/30/2022</td>
<td align="left"></td>
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<td align="left" colspan="2">Fentanyl #2 Control Number</td>
<td align="left">049323-S</td>
<td align="left"></td>
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<tr>
<td align="left" colspan="2">Fentanyl #2 Expiration Date</td>
<td align="left">04/30/2022</td>
<td align="left"></td>
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<td align="left" colspan="2">Fentanyl #3 Control Number</td>
<td align="left">049323-T</td>
<td align="left"></td>
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<tr>
<td align="left" colspan="2">Fentanyl #3 Expiration Date</td>
<td align="left">04/30/2022</td>
<td align="left"></td>
</tr>
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<td align="left" colspan="2">Midazolam Concentration</td>
<td align="left">10mg/2mL</td>
<td align="left"></td>
</tr>
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<td align="left" colspan="2">Midazolam #1 Control Number</td>
<td align="left">01184DK-K</td>
<td align="left"></td>
</tr>
<tr>
<td align="left" colspan="2">Midazolam #1 Expiration Date</td>
<td align="left">01/01/2021</td>
<td align="left"></td>
</tr>
<tr>
<td align="left" colspan="2">Midazolam #2 Control Number</td>
<td align="left">91025DK-N</td>
<td align="left"></td>
</tr>
<tr>
<td align="left" colspan="2">Midazolam #2 Expiration Date</td>
<td align="left">07/01/2020</td>
<td align="left"></td>
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<td align="left" colspan="2">Ketamine Concentration</td>
<td align="left">500mg/10mL</td>
<td align="left"></td>
</tr>
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<td align="left" colspan="2">Ketamine #1 Control Number</td>
<td align="left">1805179.1-B</td>
<td align="left"></td>
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<td align="left" colspan="2">Ketamine #1 Expiration Date</td>
<td align="left">08/28/2020</td>
<td align="left"></td>
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<td align="left" colspan="2">Ketamine #2 Control Number</td>
<td align="left">1905039.1-H</td>
<td align="left"></td>
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<td align="left" colspan="2">Ketamine #2 Expiration Date</td>
<td align="left">02/28/2021</td>
<td align="left"></td>
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<hr>
</strong></td>
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<td colspan="4" align="center"></td>
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<tr>
<td colspan="4" align="left"><br>
Nathaniel Lucido</td>
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