INTAKE AND OUTPUT MONITORING SHEET
NAME OF PATIENT: ___Mrs. X___ RM/WARD: __Delivery Room__ PHYSICIAN: __Dr. Sweet Ali__
__________________I/O q shift_______________
MEDICAL ORDER
DATE SHIFT/TIME INTAKE OUTPUT
7AM-3PM Per Orem Venoclysis NGT feeding Urine Vomitus Stool Drain
(NGT/Thorax)
05/03/21 9:30 am --------- --------- 200 cc --------- --------- ---------
05/04/21 6:42am --------- --------- 180cc --------- --------- ---------
FOR SIMULATION USE ONLY