NDH - Intake and Output Monitoring Sheet

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Notre Dame Hospital

AND SCHOOL OF MIDWIFERY

Rosary Heights, Cotabato City

INTAKE AND OUTPUT MONITORING SHEET

NAME OF PATIENT: __________________________ RM/WARD: _ PHYSICIAN: _________

_________________________________
MEDICAL ORDER
DATE SHIFT/TIME INTAKE OUTPUT

Per Orem Venoclysis NGT feeding Urine Vomitus Stool Drain

(NGT/Thorax)
FOR SIMULATION USE ONLY

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