Republic of the Philippines

Province of Zamboanga del Norte

ZAMBOANG DEL NORTE MEDICAL CENTER
Sicayab, Dipolog City
Tel. No. : (065) 212-5080, 212-4120

FLUID INTAKE AND OUTPUT SHEET

(HOURLY)

DATE 04, 27, 21

SHIFT TIME ORAL PARENTERAL OTHERS TOTAL SHIFT TIME ORAL PARENTERAL URI
7-3PM 8:00AM - 200mL - 200 mL 7-3PM 8:00AM - - 200
9:00AM - 125 mL - 125 mL 9:00AM - - -
10:00AM - 125 mL - 125 mL 10:00AM - - -
11:00AM - 125 mL - 125 mL 11:00AM - - -
12:00PM - 200 mL - 200 mL 12:00PM - - 100
1:00PM - 125 mL - 125 mL 1:00PM - - -
2:00PM - 125 mL - 125 mL 2:00PM - - 150
3:00PM - 125 mL - 125 mL 3:00PM - - 200

TOTAL: 1150 mL 1150 mL TOTAL: 650

SHIFT TIME ORAL PARENTERAL OTHERS TOTAL SHIFT TIME ORAL PARENTERAL URIN
3-11PM 4:00PM 125 mL - 125 mL 3-11PM 4:00PM - - 150
5:00PM 125 mL - 125 mL 5:00PM - - -
6:00PM 125 mL - 125 mL 6:00PM - - -
7:00PM 200 mL - 200 mL 7:00PM - - 200

8:00PM 125 mL - 125 mL 8:00PM - - -

9:00PM 125 mL - 125 mL 9:00PM - - -

10:00PM 125 mL - 125 mL 10:00PM - - 200

11:00PM 125 mL - 125 mL 11:00PM - - -

TOTAL: 1075mL 1075 mL TOTAL: 550 m

SHIFT TIME ORAL PARENTERAL OTHERS TOTAL SHIFT TIME ORAL PARENTERAL URI

11-7AM 12:00AM - 125 mL - 125 mL 11-7AM 12:00AM - - -

1:00AM - 125 mL - 125 mL 1:00AM - - 200 m

2:00AM - 125 mL - 125 mL 2:00AM - - -

 3:00AM - 125 mL - 125 mL 3:00AM - - 200 m

4:00AM - 125 mL - 125 mL 4:00AM - - -

5:00AM - 125 mL - 125 mL 5:00AM - - -

6:00AM - 125 mL - 125 mL 6:00AM - - 200 m

7:00AM - 125 mL - 125 mL 7:00AM - - -

TOTAL: 1000 mL 1000 mL TOTAL: 600 m