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Fluid Restriction Worksheet
FluidRFrDietaryBrkFastLunchSupperFrNursingDay ShiftEve ShiftNgt Shift
1000 cc 720 cc240240240 280 cc100 100 80
1100 cc 840 cc360240240 260 cc100 80 80
1200 cc 840 cc360240240 360 cc 140 140 80
1300 cc 840 cc360240240 460 cc 190 190 80
1400 cc 840 cc360240240 560 cc 240 240 80
1500 cc 840 cc360240240 660 cc 240 240 180
1600 cc 960 cc360240360 640 cc 240 240 160
1700 cc 960 cc360240360 740 cc 300 300 140
1800 cc1080 cc360360360 720 cc 300 300 120
1900 cc1080 cc360360360 820 cc 320 320 180
2000 cc1080 cc360360360 920 cc 360 360 200
2100 cc1080 cc3603603601020 cc 410 410 200
2200 cc1080 cc3603603601120 cc 460 460 200

  

  Diet


Total Dietary      Brk:    Lch:    Sup:


Total Nursing      Day:    Eve:    Night:




  Roster      Cardex      Print