Arcega, Romar Rico H.

BSN-III
I&O

Patient’s Name : ___XXXXXXXXXXXXXXXXXXXXXX__ Hospital Case No : __XXXXXXXXXXXXXX___________

Age : ____XXXXXXXXXXXX______ Sex: M [ X ] F [ X ] Civil Status :___XXXXXXXXXXXXXXXX_________
Ward / Rm No:_______XXXXXXXXXXXXXXXX______
DATE SHIFT ORAL IV TOTAL URINE EMESIS TOTAL SIGNATURE
06—02
03-12-2020 02-10 650ml None 650ml 400ml None 400ml RArcega
10-06
Total
04-12-2020 06-02 800ml None 800ml 420ml None 420ml RArcega
02-10 540ml None 540ml 285ml None 285ml RArcega
10-06
Total
06-02
02- 10
10-06
Total
06-02
02-10
10-06
Total
06-02
02-10
10-06
Total
06-02
02-10
10-06
Total