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Notre Dame Hospital and School of Midwifery

Rosary Heights, Cotabato City


PARENTERAL FLUID SHEET

Patient’s Name: ________________________ Age/Sex: _____ Room: _______ Physician: ________________

I. Intravenous Fluids
DATE BOTTLE SOLUTION VOLUME INCORPORATION TIME SIGNATU DATE/TI SIGNATU
NO. STARTED RE/ ME RE/
REMARKS CONS/DI REMARKS
SC

II. Side Drips


DATE BOTTLE SOLUTION VOLUME INCORPORATION TIME SIGNATU DATE/TI SIGNATU
NO. STARTED RE/ ME RE/
REMARKS CONS/DI REMARKS
SC
III. Blood Transfusion
DATE BOTTLE SOLUTION VOLUME INCORPORATION TIME SIGNATU DATE/TI SIGNATU
NO. STARTED RE/ ME RE/
REMARKS CONS/DI REMARKS
SC

FOR SIMULATION USE ONLY

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