ION MEDICAL CENTER

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

No.: (+632) – 881 – 1571

INTRAVENOUS FLUID SHEET

NAME: Alleah AGE: 8 y/o HOSPITAL NO.: 112222 ‎‎‎‎‎‎‎‎‎‎

SERVICE: Pediatric SEX: Female WARD/RM: Room 1‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎‎

ATTENDING PHYSICIAN: Dr. Ga ‎‎‎‎‎‎‎‎‎‎ ‎‎‎

IV AMOUNT DROPS REMARKS AND

IV PER TIME TIME AMOUNT AMOUNT
DATE FLUID IV FLUID PER NURSES’
SITE SHIFT
STARTED FINISHED INFUSED LEFT
NO. MINS. SIGNATURE’S

09-21- 1 1L PNSS R 114 ml/ 29gtts/ 10:00am 6:45pm 570ml 430ml

22 hand hr min -9/21 -9/21
(7am-
3pm)

09-21- 1 1L PNSS R 114 ml/ 29gtts 10:00am 6:45pm 430ml 0 Infusing well
22 hand hr /min -9/21 -9/21
(3pm-
11pm)

09-21- 2 1L PNSS R 114 ml/ 29gtts 6:45pm 12:00am 486ml 514ml /abcd
22 hand hr /min -9/21 -9/22
(3pm-
11pm)

09-21- 2 1L PNSS R 114 ml/ 29gtts 6:45pm 12:00am 114ml 400ml /efgh
22 hand hr /min -9/21 -9/22
(11pm
-7am)