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VITAL SIGNS

INTAKE & OUTPUT SHEET


HOSPITAL #: N/A

PATIENT’S NAME: Dela Cruz, Jose AGE: 50 Years Old SEX: Male CIVIL STATUS: Married WARD: N/A

VITAL SIGNS INTAKE OUTPUT


DATE TIME NGT
BP TEMP PR RR IV PO NGT TOTAL URINE STOOL TOTAL
VOMITUS

April 8:00 120/80 37’C 75 18


22, AM mmHg
2021

April 10:00 120/70 37.2’C 73 18


22, AM mmHg
2021

April 12:00 130/80 36.5’C 76 20


22, NN mmHg
2021

April 2:00 120/90 37.5’C 80 19


22, PM mmHg
2021

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