Fluid Chart
Patient Name: Date:
Time
|
Type of Fluid
|
Amount (In Mls.)
|
O/P/I
|
Running Total
|
||
|
|
In
|
|
Out
|
|
|
7:00
|
|
|
|
|
|
|
7:30
|
|
|
|
|
|
|
8:00
|
|
|
|
|
|
|
8:30
|
|
|
|
|
|
|
9:00
|
|
|
|
|
|
|
9:30
|
|
|
|
|
|
|
10:00
|
|
|
|
|
|
|
10:30
|
|
|
|
|
|
|
11:00
|
|
|
|
|
|
|
11:30
|
|
|
|
|
|
|
12:00
|
|
|
|
|
|
|
12:30
|
|
|
|
|
|
|
13:00
|
|
|
|
|
|
|
13:30
|
|
|
|
|
|
|
14:00
|
|
|
|
|
|
|
14:30
|
|
|
|
|
|
|
15:00
|
|
|
|
|
|
|
15:30
|
|
|
|
|
|
|
16:00
|
|
|
|
|
|
|
16:30
|
|
|
|
|
|
|
17:00
|
|
|
|
|
|
|
17:30
|
|
|
|
|
|
|
18:00
|
|
|
|
|
|
|
18:30
|
|
|
|
|
|
|
19:00
|
|
|
|
|
|
|
19:30
|
|
|
|
|
|
|
20:00
|
|
|
|
|
|
|
20:30
|
|
|
|
|
|
|
21:00
|
|
|
|
|
|
|
21:30
|
|
|
|
|
|
|
22:00
|
|
|
|
|
|
|
22:30
|
|
|
|
|
|
|
23:00
|
|
|
|
|
|
|
|
Total
|
|
** O – Oral, P – Peg, I – Intravenous
-------------------------------------------------------------------------------
When Doctor asks you to take more fluids, and Nurse is
tracking record of your fluid intake -