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  • Vital Signs and Intake/Output Form: Name of Patient: Ward/Room: Address: Age: Sex: Admission Date

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    NEVINE LOUIS DELA CRUZ
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    This document is a vital signs and intake/output form for a patient. It records their name, address, age, sex, and admission date. It then has a table to log the patient's blood pressure, temperature, pulse, respiration rate, oxygen saturation, and central venous pressure at various times throughout the day. Another table tracks what the patient has taken in, such as orally, through a feeding tube, or intravenously, and what they have output, including urine, stool, vomiting, and other miscellaneous items. The form is used to monitor the patient's condition over 24 hours.

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    MIO-sheet

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    This document is a vital signs and intake/output form for a patient. It records their name, address, age, sex, and admission date. It then has a table to log the patient's blood pressure, temperature, pulse, respiration rate, oxygen saturation, and central venous pressure at various times throughout the day. Another table tracks what the patient has taken in, such as orally, through a feeding tube, or intravenously, and what they have output, including urine, stool, vomiting, and other miscellaneous items. The form is used to monitor the patient's condition over 24 hours.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    32 views1 page

    Vital Signs and Intake/Output Form: Name of Patient: Ward/Room: Address: Age: Sex: Admission Date

    Uploaded by

    NEVINE LOUIS DELA CRUZ
    This document is a vital signs and intake/output form for a patient. It records their name, address, age, sex, and admission date. It then has a table to log the patient's blood pressure, temperature, pulse, respiration rate, oxygen saturation, and central venous pressure at various times throughout the day. Another table tracks what the patient has taken in, such as orally, through a feeding tube, or intravenously, and what they have output, including urine, stool, vomiting, and other miscellaneous items. The form is used to monitor the patient's condition over 24 hours.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    VITAL SIGNS AND INTAKE/OUTPUT FORM

    Name of Patient: Ward/Room:


    Address:
    Age: Sex:
    Admission Date:

    INPUT OUTPUT
    Date Time BP T P R O2 CVP Signature
    Sat. Oral NGT IV Blood Misc. Urine NGT Stool Emesi Misc.
    s
    12
    am
    1 am
    2am
    3 am
    4 am
    5 am
    6 am
    7 am
    Total
    8 am
    9 am
    10
    am
    11
    am
    12 pm
    1 pm
    2 pm
    3 pm
    TOTAL
    4 pm
    5 pm
    6 pm
    7 pm
    8 pm
    9 pm
    10 pm
    11 pm
    TOTAL
    24 HOURS TOTAL

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