INTAKE & OUTPUT MONITORING SHEET

SURNAME: patient k M.I.: AGE: HOSPITAL NO.:

GIVEN NAME: SEX: WARD/ROOM NO.:

INTAKE OUTPUT
Date Time Shift IVF Oral/NGT TOTAL Urine Drain TOTAL
12-09- 3:00 7-3 100 ml 800 ml 900 2x (500 ml 1 stool 1150 ml
2020 pm and 650 ml)
11:00 3-11 900 ml 580 ml 3x (300 ml, 1 stool 1400 ml
pm 700 ml, 400
ml)n
11 11-7 1000 ml 0 550 ml 0 0
pm
TOTAL: 1000 ml 1380 ml 2380 ml 3100 ml 2 stool 3100 ml

12-11- 3 pm 7-3 766.6 ml 1350 ml 1350 3650 ml 5 stool 3650 ml

2020
11 3-11 666.6 ml 1090 ml 1090 2680 ml 1 stool 2680 ml
pm
7 am 11-7 666. ml 1400 ml 1400 ml 1200 ml 0 1200 ml
TOTAL: 2899.8 ml 3840 ml 6739 ml 7530 ml 6 stool 7530 ml