Intake Outlet Entry

INTAKE OUTPUT ENTRY

Patient ID		Patient Name		Doctor
Ip #		Admission Date		Nursing Station
Room		Bed		Weight

Sl#	DATE	INTAKE									OUTPUT									BALANCE				InTotal
	DATE	NGT	ORAL		PARENTERAL		OTHER		InTake		NGT	OTHER	DRAINAGE				URINE	OTHER		BALANCE				OutTake
									Total											Total					OutTotal
	Time	ml	Item	ml	Item	ml	Item	ml			ml	1	2	3	4	ml	Item	ml		Balance	Remarks

Sl#	DATE	INTAKE									OUTPUT									BALANCE				InTotal
	DATE	NGT	ORAL		PARENTERAL		OTHER		InTake		NGT	OTHER	DRAINAGE				URINE	OTHER		BALANCE				OutTake
									Total											Total					OutTotal
	Time	ml	Item	ml	Item	ml	Item	ml	ml			ml	1	2	3	4	ml	Item	ml		Balance	Remarks

Infusion/Transfusion Entry