Intake and Output Record


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What Is the Blank Intake and Output Record?

The fillable blank Intake and Output Record (OR-FN-HS-NU-36) is a document used to track how much the person drinks and how much and of what type is the output.

Intake and Output Record Screenshot

What I need the blank intake and output record for?

To track the fluid intake and output of a patient.

How to Fill Out the Blank Intake and Output Record?

The first step to properly fill out the printable blank Intake and Output Record is to enter the date and the name of the patient on the top of the form. The second section is for the actual records of intake and output and it has to be filled out carefully.

The equivalents for the records are present in the form to help you fill it out more accurately. The section is divided into two parts: records of intakes and records of outputs. The intakes section requires you to enter the time, the amount and the type of the intake each time the person drinks. It is important to enter all the fluids consumed by the patient: water, milk, soup, coffee, tea, soft drinks, juices, ice cream and other.

The part with the output records implies entering the time of the output, its amount and its type. It is also necessary to record all the liquid outputs, including urine, vomitus, excessive perspiration, blood and wound drainage, liquid stools and others.

Organizations that work with the blank intake and output record

  • Healthcare organizations in the state of Indiana

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Fillable online Intake and Output Record
(4.5 / 5) 54 votes
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