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    Formulir Pemantauan Intake Dan Output Cairan: No Form: RM/03/14/2016

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    feblina yanti
    This document is a fluid intake and output monitoring form for a patient in a hospital room. It tracks intake (oral, IVFD, NGT, urine, vomiting) and output (drain, bowel movement, insensible water loss) amounts over four six-hour periods each day. The form is used to calculate daily fluid balance for the patient.

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    Formulir Pemantauan Intake Dan Output Cairan: No Form: RM/03/14/2016

    Uploaded by

    feblina yanti
    22 views2 pages
    This document is a fluid intake and output monitoring form for a patient in a hospital room. It tracks intake (oral, IVFD, NGT, urine, vomiting) and output (drain, bowel movement, insensible water loss) amounts over four six-hour periods each day. The form is used to calculate daily fluid balance for the patient.

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    form intake output

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    This document is a fluid intake and output monitoring form for a patient in a hospital room. It tracks intake (oral, IVFD, NGT, urine, vomiting) and output (drain, bowel movement, insensible water loss) amounts over four six-hour periods each day. The form is used to calculate daily fluid balance for the patient.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    22 views2 pages

    Formulir Pemantauan Intake Dan Output Cairan: No Form: RM/03/14/2016

    Uploaded by

    feblina yanti
    This document is a fluid intake and output monitoring form for a patient in a hospital room. It tracks intake (oral, IVFD, NGT, urine, vomiting) and output (drain, bowel movement, insensible water loss) amounts over four six-hour periods each day. The form is used to calculate daily fluid balance for the patient.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 2

    No Form : RM/03/14/2016

    No RM :
    Nama :

    PEMERINTAH DAERAH KHUSUS IBUKOTA JAKARTA Tgl Lahir : Laki-Laki / Perempuan

    RUMAH SAKIT UMUM DAERAH TARAKAN (Bila ada, Tempel Label Identitas)
    Jl. KyaiCaringin No. 7 Jakarta Pusat, Telp 021-3503150 | 021 - 3503003

    FORMULIR PEMANTAUAN INTAKE DAN OUTPUT CAIRAN


    Ruangan : …………………………………………….
    TGL JAM INTAKE OUTPUT BALANCE
    Oral IVFD NGT Urin Muntah Drain BAB IWL
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH

    Halaman 1
    TGL JAM INTAKE OUTPUT BALANCE
    Oral IVFD NGT Urin Muntah Drain BAB IWL
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH
    06-00-12.00
    12.00-18.00
    18.00-24.00
    24.00-06.00
    JUMLAH

    Halaman 2

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