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Patient Intake and Output Chart

The document is an intake and output chart for a patient, capturing their name, age, sex, and hospital number. It details the patient's fluid intake and output over the past 24 hours, including various sources such as oral, IV, and drainage. The chart is structured to record hourly data for medication, nutrition, and other fluids.

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pvrcnvja
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56 views1 page

Patient Intake and Output Chart

The document is an intake and output chart for a patient, capturing their name, age, sex, and hospital number. It details the patient's fluid intake and output over the past 24 hours, including various sources such as oral, IV, and drainage. The chart is structured to record hourly data for medication, nutrition, and other fluids.

Uploaded by

pvrcnvja
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

PATIENT’S NAME: …………………………………………………… AGE: ……… SEX: ……… IP No: …………

INTAKE AND OUTPUT CHART


Name: Age: Sex: Hosp No:

Unit: Ward: Date:

Past 24 Hrs. Intake: Past 24 Hrs. Output:


ORAL Urine
IV NASOGASTRIC ASPIRATION
Other Drainage
Other
Total Total
INTAKE OUTPUT
(Medication Oral Urine N. Drainag Other Signatur
Nutrition Fluids, (Medication, G. e e
Hours Blood) Food) Asp
Fluids Hrly Total Fluid Amount
6-00AM
7-00
8-00
9-00
10-00
11-00
12-00PM
1-00
2-00
3-00
4-00
5-00
6-00
7-00
8-00
9-00
10-00
11-00
12-00AM
1-00
2-00
3-00
4-00
5-00

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