VENOCLYSIS SHEET

Name:Aquino,Katherine Admitting Diagnosis:(PTB) Hospital No:

Age:22y/ Sex:F Date of Attending Physician: Room/Bed
o Admission:2/24/22 Dr.William Ong No:507
7:00 am

DATE AMOUNT BOTTLE SITE ADDITIVE RATE TIME TIME REMARKS

AND TYPE NO. STARTED/ CONSUMED/
OF STARTED CONSUMED
SOLUTION BY BY
2/24/22 non
 INTAKE AND OUTPUT (I&O) SHEET
Name: Admitting Diagnosis: Hospital No:

Age: Sex: Date of Admission: Attending Physician: Room/Bed No:

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

 VENOCLYSIS SHEET

Name:Manolo,Lorenze Kyle Admitting Diagnosis:Dengue Hospital No:

Age:23y/ Sex:M Date of Attending Physician: Room/Bed No:508

o Admission:2/26/22
Dr.John Ramirez
6:00 am

DATE AMOUNT BOTTLE SITE ADDITIVE RATE TIME TIME REMARKS

AND TYPE NO. STARTED/ CONSUMED
OF STARTED /
SOLUTION BY
CONSUMED
BY

2/26/22 D5LR #1 Side 750ML 8:00am CREDIT:

drip
B.M 250 ml
left
 INTAKE AND OUTPUT (I&O) SHEET
Name: Admitting Diagnosis: Hospital No:

Age: Sex: Date of Admission: Attending Physician: Room/Bed No:

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY

DATE INTAKE TOTAL OUTPUT TOTAL

IVF ORAL BLOOD OTHERS URINE STOOL VOMITUS OTHERS

6-2

2-10

10-5

TOTAL PER DAY TOTAL PER DAY