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TWENTY-FOUR HOUR PATIENT INTAKE AND OUTPUT WORKSHEET
(DD FORM 792)
The Twenty-Four Hour Patient Intake and Output Worksheet (figures 1-4 and
1-5) is used to record the amount of liquid that the patient takes into his body and the
amount of liquid that the patient's body loses. In a normal healthy adult, the intake (the
amount taken into the body) is about the same as the output (the amount lost by the
body). This balance between liquid intake and liquid output is called the fluid balance.
A physician may order that a Twenty-Four Hour Patient Intake and Output Worksheet
(usually called the Intake and Output (I&O) Worksheet be maintained for a patient
whom he suspects has had or will have an abnormal fluid loss or gain. Information from
the I&O Worksheet may also be used in computing intravenous (IV) therapy. The form
is kept by the patient's bed so I&O can be recorded conveniently. A "Measure Intake-
Output" sign is usually attached to the patient's bed to remind personnel that all liquid
I&O must be recorded. After receiving proper instructions, the patient and even visitors
can assist nursing personnel by measuring and recording I&O data. The I&O
Worksheet may be completed either in pencil or in pen. After the worksheet has been
completed, the sums are recorded either on the patient's Vital Signs Record (SF 511) or
in the Nursing Notes (SF 510). The worksheet is usually destroyed once the
information has been transcribed to the proper form.
Figure 1-4. DD Form 792, Twenty-Four Hour Patient Intake and Output Worksheet (top
[intake] section).
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