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pmsh - form no.

8
PAMPANGA MEDICAL SPECIALIST HOSPITAL
Olongapo-Gapan Road, San Antonio, Guagua, Pampanga

Surname : ___________________________________ Age ASR No.

Given Name : __________________________M.I. _____ Sex M F Ward/Room #

INTRAVENOUS FLUID SHEET


TIME STRD. NURSE
DATE SHIFT BOT. NO. KIND OF SOLUTION GTTS. CONS REMARKS SIG

Please sign every entry

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