COAHS MEDICAL CENTER

J. P. Rizal Extension, West Rembo, Makati City 1215

Telephone No. : (+632) – 881 – 1571

INTRAVENOUS FLUID SHEET

NAME: ____FE SANTOS___________ AGE: __54__________ HOSPITAL NO.: ______________

SERVICE: ________________________ SEX: __F___________ WARD/RM: __FEMALE WARD______

ATTENDING PHYSICIAN: ___DR. RODRIGUEZ MD.______________________________________

MINUTE DROPS PER

STARTED TIME

FINISHED TIME
PER SHIFT AMOUNT

INFUSED AMOUNT
IV FLUID NO.

LEFT AMOUNT
REMARKS
IV SITE
DATE IV FLUIDS AND NURSE’S
SIGNATURE

14/10 #1 PNSS radial 1L 27- 7:00 7:00 667m 333 j.palisoc

28 AM PM l ml ml
gtts
14/10 #2 To follow PNSS radial 1L 41- 7:00 3:00 - - -
42 PM AM
gtts

COAHS-CON2018-RLE-IVF