Three Day Bladder Chart
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1Document No: ________________________
Three Day Bladder Chart
Please complete details for each time the resident passes urine.
ID LabeL
Complete each day for 3 complete days (identify which day)
Day__________________________Date__________________
Time
Drinks
Continent
Incontinent
No. of pad and/or
Comments
(amt, type)
Yes/No
Yes/No
clothing changes
(assoc. circumstances,
(ie.
Degree of wetness:
effect on daily activity)
In toilet)
Pad only.
Pad & underwear.
Pad, underwear &
outer clothing.
(Example)
0800
Cup of tea
No
Yes- pad only
1 change of pad
unable to get to toilet
Waking to morning tea
Morning tea to lunch
Lunch to afternoon tea
Afternoon tea to dinner
Dinner to bed
Overnight
Developed by Deakin University and funded under the National Continence Management Strategy
2
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Parent category: Medical