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HHC Health & Home Care Clinical Policy And

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<strong>HHC</strong> HEALTH & HOME CARE Section: 12-1<br />

Nutrition __RN<br />

FOOD RECORD FOR MEALS/SNACKS<br />

Keeping a food record will help your dietitian or nurse get a better idea of food items, calories or<br />

nutrients you are eating. You will have one sheet for each day the dietitian has asked you to record.<br />

This may seem like a lot of work, but it will help us help you!<br />

Instructions:<br />

• Please write down everything you eat and drink each day; be as specific as you can. Include meal or<br />

snack times.<br />

• Include the name of every food you eat<br />

Examples: Not just sandwich, but bologna sandwich<br />

Not just salad, but lettuce and tomato<br />

salad<br />

• Include the amount of each kind of food and beverage you have.<br />

Examples: 2 slices rye bread with 2 slices bologna and 1 tablespoon mayonnaise<br />

1 cup of black coffee with 2 teaspoons sugar<br />

• Include whether food was raw or cooked; if cooked, tell how.<br />

Examples: 2 fried eggs, 2 slices roast chicken with gravy<br />

• Include brand names.<br />

• Include SUPPLEMENTS like Ensure, Sustacal.<br />

______________________________________<br />

<strong>Clinical</strong> Dietitian or Nurse<br />

THANK YOU FOR YOUR HELP!<br />

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