SOUTHERN PHILIPPINES MEDICAL CENTER

Nutrition and Dietetics Service

24-HOUR FOOD RECALL

Patient D, J L. Date Feb-20-2023
Ward /Rm MBC
Diet Order Full Diet

Meal Food Items Household Intake TO BE FILLED BY THE DIETITIAN

Measure CHO CHON FAT Calories
(g) (g) (g) (kcal)
Breakfast Lugaw, Thick 1 ½ Cup 1 ½ Cup 23 2 - 100
Pamahaw Bear Brand, swack 1 Sachet 1 Sachet 18.5 5 6.6 153

Time:
AM Snack Orange, ponkan 1 pc 1 pc 1- - - 40
Merienda sa buntag Biscuit, Fita 6 pcs 6 pcs 21 2 6 140

Time:
Lunch Lugaw, Thick 1 ½ Cup 1 ½ Cup 23 2 - 100
Paniudto

Time:
PM Snack Biscuit, Fita 6 pcs 6 pcs 21 2 6 140
Merienda sa hapon

Time:
Dinner Lugaw, Thick 1 ½ Cup 1 ½ Cup 23 2 - 100
Panihapon

Time:
MN Snack
Merienda sa gabii

Time:
TOTAL 139.5 15 18.6 773

Nutrient Required Actual Adequacy Remarks -Inadequate Intake

(g) (g) (%)
Total Energy 4,040 773 19.13
Carbohydrates 575 139.5 24.26
Protein 189 15 7.93
Fat 110 18.6 16.90 Clinical Dietitian
License No.

SPMC-F-NDS-13 Date of Effectivity: January 13, 2020 Rev. O Page 1 of 1

 SOUTHERN PHILIPPINES MEDICAL CENTER
Nutrition and Dietetics Service

24-HOUR FOOD RECALL

Patient D, J L. Date Feb-21-2023
Ward /Rm MBC
Diet Order Full Diet

Meal Food Items Household Intake TO BE FILLED BY THE DIETITIAN

Measure CHO CHON FAT Calories
(g) (g) (g) (kcal)
Breakfast Rice 1/2 cup 1 Cup 46 4 - 200
Pamahaw Egg, boiled 1 pc, medium 1 pc, m - 8 6 86
Hotdog, red 2 pcs 1 pc 5 4 5 81
orange 1 pc 2 pcs 20 - - 80
Mango, ripe 1 slice 1 slice 10 - - 40
Boost optimum 1 Scoop 7 scoops 29.26 9.87 9.59 249.9
Time:
AM Snack Royal Tru, soft drink 1 bot. 200 ml 200 ml 16 - - 64
Merienda sa buntag Biscuit, Fita 1 sachet 1 sachet 21 2 6 140

Time:
Lunch Rice ½ Cup 1 Cup 46 2 - 100
Paniudto Egg, boiled 1 pc, medium 1 pc, m
Adobo, pork 1 slice 1 slice
Orange 1 pc 2 pcs

Time:
PM Snack Rebisco plain crackers 1 sachet 1 sachet 21 2 6 140
Merienda sa hapon Boost optimum 1 scoop 7scoops

Time:
Dinner Rice ½ Cup 1 Cup 23 2 - 100
Panihapon Fish, Fried 1 pc 1 pc
Mango, ripe 1 slice 1 slice

Time:
MN Snack
Merienda sa gabii

Time:
TOTAL 139.5 15 18.6 773

Nutrient Required Actual Adequacy Remarks -Inadequate Intake

(g) (g) (%)
Total Energy 4,040 773 19.13
Carbohydrates 575 139.5 24.26
Protein 189 15 7.93
Fat 110 18.6 16.90 Clinical Dietitian
License No.

SPMC-F-NDS-13 Date of Effectivity: January 13, 2020 Rev. O Page 1 of 1