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FOOD AND FLUID CHART
Please record the Food and Fluid on this chart for PEG Feed clients. Otherwise make sure you record your
clients hydration on PASS. It is so important that our clients have enough fluid to prevent UTI's and stay hydrated!
Clients Name Date of Birth
Date
Time
Food intake (type & amount)
Fluid intake (type & amount)
Output (urine amount) Pad changing frequency
Bowel movement (yes/no) Grade
Support worker (printed name) Signature
