Name of Client / Patient: Arianne Daphne Felipe Age: 19

Name of Interviewer: Preciuos Joy Tobias

Date of Interview: 10/8/2023

Supplements Consumed (What, When, Dose, Brand / Manufacturer):

Physical Activity (What, When, Duration, Intensity)

Total
Quantity / Amount Total Protein
Method of Preparation / Consumed Energy Content Carbohydrate
Meal Pattern Time Food / Beverage Consumed Consumed (in household Content
Brand Name Where (in kcal) Content
measure) (in grams)
(in grams)
rice 1 cup boiled 184 46 _
pork, liempo 4 slices vinegar-braised/adobo 504 _ 36
boarding house
Breakfast 8:00 AM coffee 1 cup 3in1 nescafe 108 26 1
water 1 glass _ _ _

ensaymada 2 pcs baked 216 46 8

boarding house
water _ _ _
Morning (AM)
9:30
Snack

coffee 1 cup 3in1 nescafe 108 26 1

bread, wheat 3 pcs JMD boarding house 216 46 8
Lunch 12:30 saging banana 1 pc boiled 92 23 _

hotdog roll 3 pcs fried 414 69 12

maja mais 2 slices friend's house 184 46 _
Afternoon (PM)
3:30 soft drinks 1 glass/bottle 100 25 _
Snack
oil (hotodg roll) 2 tsp 90 _ _

pancit, bihon 2 cups sauteed 184 46 _

friend's house
water 1 glass _ _ _
Dinner 7:00

Bedtime (BT)
Snack
Bedtime (BT)
Snack

SUM 2400 399 66

 Total Fat
Content
(in grams)

_
40
_
_

_
_

_
_
_

_
_
10

_
_
50