Follow the steps to fill out the Southern Anesthesia Form accurately.

1. Click the ‘Get Form’ button to obtain the Southern Anesthesia Form and open it in your editing interface.
2. Enter the name of the supplier as 'Southern Anesthesia & Surgical, Inc.' This ensures the order reaches the appropriate provider.
3. Fill in the supplier's street address: 'One Southern Court,' along with the city and state as 'West Columbia, SC 29169.' Accurate address information is crucial.
4. Record today's date in the section labeled 'Date.' This should be the current date when you are completing the form.
5. Indicate the number of packages you are ordering in the 'Number of Packages' field. Ensure this reflects the total quantity desired.
6. Specify the size of each package, for example, '20ml' or '10x5ml,' in the designated field. This detail is important for accurate fulfillment.
7. In the 'Name of Item' section, describe each drug you are ordering, using the appropriate terms such as ' vial' or ' 50mg/ml.' This should accurately reflect the product specifications.
8. Complete the 'Last Line Completed' section, noting the line number of the last entry related to your order. This helps maintain clear tracking of your requests.
9. Sign the form in the 'Signature of Purchaser' area. Unsigned forms will not be processed. If signing on behalf of the physician, ensure you have the necessary Power of Attorney documentation.
10. Once all sections are completed, review the form for any potential errors. Remember, any mistakes cannot be altered and will require a new form. Ensure clarity and correctness.
11. Mail the top two copies (Brown & Green) of the form to Southern Anesthesia & Surgical, Inc. Retain the remaining blue copy for your records.

Complete your Southern Anesthesia Form online today to streamline your ordering process!