PAKISTAN INSTITUTE OF MEDICAL SCIENCES

CHILDREN HOSPITAL

MEDICAL RECORD INTAKE OUTPUT SHEET

25/Aug/2016 12:44:16

Patient Name : M Qasim

PCN : C-08/16/21269

S/O : M Hafeez

CNIC : 12101-2145454-5

Room # : EAST MW (General) / 12/34

Date Admission : 08-24-2016

Gender : Male

Age : 2 Years

Phone : , 0122-4565425

No. Of Days : 1

Date Of Discharge :

Consultant Name : Dr. NASERA BHATTI

Address : ,

Date

Time
Period

25/08/2016 12:00
Total

Intake

Output

Oral

CVP Line

Parenteral

N/G

Other

180

180

Total Intake

Urine Dip Stick

Drainage

NG Aspiration

Vomit

Vomit Color

Stool

Urine

Other

white

80

80

180

Total

PH

Bld

Sug

Ket

ALB

INITIAL
NA

80