INTAKE and OUTPUT Record INTAKE and OUTPUT RECORD

Patient initials: Patient initials:

Room number: Room number:
Date: Date:

INTAKE OUTPUT INTAKE OUTPUT

broth/soup - 8 oz. - 240 ml
coffee - 8 oz. - 240 ml
ice cream - 4 oz. - 120 ml
jello - 5 oz. - 150 ml
juices - 6 oz. - 180 ml.
juice - 4 oz. - 120 ml
milk - 8 oz. - 240 ml
popsicle - 3 oz. - 90 ml
tea - 8oz. - 240 ml
broth/soup - 8 oz. - 240 ml
coffee - 8 oz. - 240 ml
ice cream - 4 oz. - 120 ml
jello - 5 oz. - 150 ml
juice - 6 oz. - 180 ml.
juice - 4 oz. - 120 ml
milk - 8 oz. - 240 ml
popsicle - 3 oz. - 90 ml
tea - 8oz. - 240 ml
 
 
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limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability or
ownership.
 

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