Filamer Christian University Hospital Inc.

Roxas City, Capiz

Name of Patient: Age: Sex: Room No.:

Attending Physician/s: Hospital No.:

PARENTERAL/INTRAVENOUS FLUID SHEET

Date Shift Bottle Kind of Medication Volume/Rate Date/Time Date/Time Remarks

No. solution Added started by: Consumed
 Nurse’s Notes
Name of Patient:______________________________________Age:_________________Sex:________________

Attending Physician:___________________Hospital No:.___________________Room:____________________

Date & Date &

Assessment and Interventions Assessment and Interventions
Time Time
 Nurse’s Notes
Name of Patient: Age: Sex:

Attending Physician: Hospital No.: Room:

Date & Date &

Assessment and Interventions Assessment and Interventions
Time Time