Monitoring Sheet: Logo Form No.: Revision No.: Effectivity Date: WEIGHT

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Republic of the Philippines

Department of Health
UNIVERSITY OF THE CORDILLERAS HOSPITAL
logo Baguio City
Form No.:
MONITORING SHEET Revision No.:
Effectivity Date:

WEIGHT:________________

DATE/ O2 ADDITIONAL PARAMETERS AS ORDERED


BP CR RR TEMP. URINE STOOL
TIME SAT.
11-30-2021
10:00 am 100/60 85 18 36.6 98 2 1

2:00 pm 110/75 80 17 36.2 99 3 1

Name of Patient: ____Benilda mae Tandoc___________ Hospital No.:_________

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