Dialysis Treatment Record
Daily Treatment Record for:
*
Patient's name
Month
*
Please Select
January
February
March
April
May
June
July
August
September
October
November
December
Year
*
Please Select
2014
2015
2016
Data
Date
*
Weight (kg)
*
BP
*
Pulse
*
Modality
*
Machine
Manual
Machine Section
Machine
Bags Used
1.5%
2.5%
4.25%
iDrain
*
Total UF
*
Avg. Dwell Time
End Machine
Manual Section
Manual
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Bags Used
*
1.5 %
2.5%
4.25%
Vol Out
*
Vol In
*
Drainage
*
Clear
Cloudy
End Manual
Submit
Clear Form
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