Client Assessment Assignment
ksamuels1359
24HourDietaryRecallTemplate.docx24-Hour Dietary Recall Template
Person’s first and last initials: P.S. Age: 35
Date assessment was done: 12/2/2020 Date of dietary recall: 12/1/2020
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Time |
Food eaten Describe the food, how it was prepared and served |
Serving size Give specific amount eaten |
Total calories |
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Person fast until 1pm |
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1300 |
4 strips of bacon with 2 boiled eggs with a bottle of water |
2 large eggs boiled 4 strips of bacon |
328 |
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1700 |
Half a turkey sandwich with 1 slice of cheese, tbsn mayo and mustard with 1 slice of lettuce with a bottle of water |
1 slice of wheat bread 2 slices of turkey ½ slice of cheese Mustard Mayonnaise lettuce |
489 |
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2000 |
4 oz of baked chicken, 2 cups of green beans and 1 cup of brown rice with a bottle of water |
4 oz chicken breasts cooked in chicken broth, 2 cups of green beans from the can, Brown rice cooked in chicken broth with butter |
500 |
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2200 |
1 cup of frozen grapes |
About 12 Green grapes |
30 |
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Nutrients |
Amount consumed in 24-hour period |
Recommended daily amount |
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Total calories |
1347 |
2200 |
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Calories from proteins: Kcal and % total calories |
584 |
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Calories from fats: Kcal and % total calories |
102 |
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Calories from carbohydrates: Kcal and % total calories |
285 |
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Vegetables (number of servings) |
35 |
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Fruits (number of servings) |
30 |
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Grains (number of servings) |
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Dairy (number of servings) |
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Height in inches |
Weight in pounds |
Body Mass Index |
Category |
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67 inches |
270 |
42.3 |
Obese |
You may add or delete rows as needed in the top portion of this template where the food and drink eaten is recorded.
After completing this template, upload it to Canvas.
