This document appears to be a medical record template for tracking patient information like name, age, weight, and hourly fluid intake and output over a 24 hour period. It includes spaces to record things like intravenous fluids administered, urine output, and beginning and end fluid balance totals.

1. NOMBRE: …………………………………………… EDAD:………………………………
FECHA:………………………………………………… PESO:.................................
HC:……………………………………………………….
PARENTERAL
HORA V.O. CANT. TIPO CANT. P.I. ORINA OTROS CANT.
8–9
9 – 10
10 – 11
11 – 12
12- 13
13 - 14
T. INGRESO B. H.
T. EGRESO D. U.
14 – 15
15 – 16
16 – 17
17 – 18
18 – 19
19 - 20
T. INGRESO B. H.
T. EGRESO D. U.
20 – 21
21 – 22
22 – 23
23 – 24
24 – 01
01 - 02
T. INGRESO B. H.
T. EGRESO D. U.
02 – 03
03 – 04
04 – 05
05 – 06
06 – 07
07 - 08
T. INGRESO B. H.
T. EGRESO D. U.
TOTAL INGRESOS:………………………………………………… BALANCE HIDRICO:……………………………………………….