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Patient Intake and Output Chart

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71 views1 page

Patient Intake and Output Chart

Uploaded by

susen7pius
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

GOVERNMENT OF MEGHALAYA

HEALTH & FAMILY WELFARE DEPARTMENT

INPUT OUTPUT CHART

Patient's Name: MRD No./UHID No.


Age: Gender M F O Ward No.
Date of Admission DD/MM/YY Bed No.
Provisional Diagnosis:

INTAKE OUTPUT Name and


Date Oral /Ryles Nurse's
Time I.V.Fluid Time Urine Vomit Drainage/Aspirations Signature
Tube

Name of Nurse In charge/Supervisor: ____________________ Signature: _______________ Date: ______________

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