Intake & Output Summary

Shift-based fluid balance tracking and documentation.

For educational use only. Always verify with clinical judgment and facility protocols.

Intake & Output Summary

Shift-based fluid balance tracking and documentation.

Shift

Intake

IV Fluids (mL)

IV Medications/Piggybacks (mL)

PO/Tube Feed (mL)

Blood Products (mL)

Other Intake (mL)

Total Intake: 0 mL

Output

Urine (mL)

Emesis (mL)

Drain Output (mL)

Blood Loss (mL)

Other Output (mL)

Stool

Total Output: 0 mL

Net Balance

Net: +0 mL

24hr Running Total

24hr Running Total (mL, optional)

Provider Notified

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INTAKE & OUTPUT SUMMARY SHIFT: Day 0700-1500. INTAKE: IV fluids 0mL. IV meds 0mL. PO/TF 0mL. Blood products 0mL. Other 0mL. TOTAL INTAKE: 0mL. OUTPUT: Urine 0mL. Emesis 0mL. Drains 0mL. Blood loss 0mL. Other 0mL. Stool: None. TOTAL OUTPUT: 0mL. NET BALANCE: +0mL.

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