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Patient Name: ________________________

Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:

Patient Name: ________________________


Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:

Patient Name: ________________________


Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:

Patient Name: ________________________


Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started:
Patient Name: ________________________
Rm.#___
Bottle #: ___ IVF Fluids:
_______________________
Drug Incorporation:
Flow Rate: ___ gtts/min _____ cc/hr
Date & Time Started: