INTRAVENOUS FLUID FLOW SHEET

SURNAME AGE HOSPITAL NUMBER

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GIVEN NAME M.I. SEX WARD BED NO.:
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I.V. FLUID DATE & NURSE’S TYPE OF I.V. DRUG TYPE OF FLOW RATE/ DATE & NURSE’S REMARKS
BOTTLE NO. TIME SIGNATURE FLUID & ADDITIVES CANNULAE/ INFUSION TIME SIGNATURE
STARTED VOLUME NEEDLE & DEVICE CONSUMED
LOCATION
OF
INSERTION