| Time | Intake (ml) | Output (ml) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| PO | IV Fluids | Tube Feeding | Other | Urine | Emesis | NG | Stool | Other | |
| TOTAL | TOTAL | ||||||||
| Shift Total (ml) | 24 Hour Balance (ml) | |||
|---|---|---|---|---|
| Morning Shift | Intake | Total Intake | ||
| Output | ||||
| Afternoon Shift | Intake | Total Output | ||
| Output | ||||
| Night Shift | Intake | Difference | ||
| Output | ||||
| Shift | ||||
|---|---|---|---|---|
| 07:00-15:00 | 15:00-23:00 | 23:00-07:00 | ||