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REPUBLIC OF THE PHILIPPINES

Province of Bukidnon
Malaybalay City

BUKSU HOSPITAL

NAME OF PATIENT: AGE/SEX:


STATUS: WARD/ROOM:
ATTENDING PHYSICAN:

INTAKE & OUTPUT MONITORING SHEET

INTAKE OUTPUT
DATE TIME ORAL PARENTERAL TOTAL URINE DRAINAGE OTHERS TOTAL
11-7

7-3

3-11

TOTAL

11-7

7-3

3-11

TOTAL

11-7

7-3

3-11

TOTAL

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