PARENTERAL SHEET

TYPE AND AMOUNT OF

TIME NO. OF PRINTED NAME &
DATE FLUID/BLOOD RATE REMARKS
STARTED BOTTLE SIGNATURE
PRODUCTS/ADDITIVES

October 8:15 D5 0.3% NaCl 500cc Raynard Maestrado

07, AM 1 40cc/ Started
2022 hr Venoclysis
October 8:00 Followed Up Raynard Maestrado
08, AM 2 40cc/
2022 D5 0.3% NaCl 500cc hr

NAME: Mara K. Halili_________ AGE: 4 months oldSEX: Female WARD: Pedia Ward BED NO.: 1

Effectivity Date: 03/04/202 REV. No.: 02 GCGMH-F-NUR-50

This form is used for educational purposes only and with approval from the concerned agency. Strictly not for reproduction.