EMILIO AGUINALDO COLLEGE

School of Nursing

February 19, 2022 (6:00am – 2:00pm)

INPUT and OUTPUT LOG SHEET

INPUT OUTPUT
Room – Bed Patient’s Name ORAL PARENTERAL TOTAL URINE STOOL OTHERS TOTAL
Number

Prepared by: Noted by:

Student Head nurse Clinical Instructor

 EMILIO AGUINALDO COLLEGE

School of Nursing

February 19, 2022 (6:00am – 2:00pm)

VITAL SIGNS MONITORING SHEET

Room & Bed Patient’s Name 8am 12pm

No.
BP Temp PR RR BP Temp PR RR

Prepared by: Noted by:

Student Head Nurse Clinical Instructor

 EMILIO AGUINALDO COLLEGE

School of Nursing

February 19, 2022 (6:00am – 2:00pm)

ROOM NO. PATIENT’S NAME BOTTL IVF HOURS RATE TIME DATE/TIME AMOUNT IVF CHECK LEVEL
E NO. TO RUN (GTTS/ STARTED RECEIVED FROM TIME ENDORSE
MIN) LAST SHIFT NEXT SH

IV FLUID SHEET/ SHIFT

Prepared By: Noted By:

Student Head Nurse Clinical Instructor