Scribd
Upload
2 views7 pages

10. 10 set

The document outlines a comprehensive lifestyle management and therapeutic diet plan for a patient, detailing personal information, health observations, and dietary habits. It includes advice on lifestyle modifications across various health aspects and provides a structured diet plan with specific timings and food items. The document serves as a guide for improving the patient's overall health and well-being.

Uploaded by

sakshi55kala
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
2 views7 pages

10. 10 set

The document outlines a comprehensive lifestyle management and therapeutic diet plan for a patient, detailing personal information, health observations, and dietary habits. It includes advice on lifestyle modifications across various health aspects and provides a structured diet plan with specific timings and food items. The document serves as a guide for improving the patient's overall health and well-being.

Uploaded by

sakshi55kala
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 7

4.

Lifestyle management’ counselling and Therapeutic Diet sheet

Name of the patient: Diet pattern:

Age/Sex: Date:

OPD/IPD No: Occupation:

Referringconsultant:

Chief complaints for which patient got admitted:

General examination findings:


Height:
Weight:

BMI status:

BP:

HR:
Other systemic examination findings
Whether K/C/O DM, HTN, allergic to any drugs? On regular medication? If Yes,

Details Diagnosis:

Treatment details in brief:

On-going procedure:

1. Life style Observations

Observations Specific observations


if any

1 Physical health

2 Psychological health

3 Family Health

4 Occupational health

5 Financial health

6 Social health

2
2. Daily routine observations:

Particulars Observations

1 Waking up time

2 Oral hygienic practices

3 Physical exercises/Yoga
practices/brisk
walking / jogging / swimming /
meditation/others
4 Working pattern-
official/sedentary/laborious/
stressful

5 Evening routine

6 Habits

7 Sleeping time

8 Duration of sleep and nature of


sleep

3
3. Dietary Observations

Particulars

1 Diet pattern – vegetarian


/nonveg/vegan/ovovegetarian

2 Timings of food intake -


Morning
drink/Breakfast/mid-
day snacking/lunch/high
tea/dinner
3 Food quantity and quality
analysis

4 Nutritional analysis of food in all


serving times

4
Advices:
1. Life style modifications:

Modifications advised
1 Physical health

2 Psychological health

3 Family Health

4 Occupational health 1. Fix working hours

2. Schedule the work

3. Mark priority to the assigned work and work accordingly

4. Cooperation and coordination with workmates

5. Patience while completing the tasks

5 Financial health

6 Social health

5
2. Daily routine practices advise:

Particulars Modification advises


1 Waking up time
2 Oral hygienic practices

3 Physical exercises/Yoga practices/brisk


walking/jogging/swimming/meditation
/others

4 Working pattern-
official/sedentary/laborious/stressful

5 Evening routine

6 Habits

7 Sleeping time

8 Duration of sleep and nature of sleep

6
3. Dietetic advice
Particulars Modification Advises
1 Diet pattern – vegetarian
/nonveg/vegan/ovovegetarian

2 Timings of food intake


Morning drink/Breakfast/
midday snacking/lunch/high
tea/dinner
3 Food quantity and quality analysis

4 Nutritional analysis of food in all


serving times

Formulated diet plan


Timing Food items with serving size Other additional
+/_ 15 information
min
Morning 6am
drink

Breakfast 8.30am

Lunch 1.30pm

Evening 5pm
high tea
time
Dinner 8pm

You might also like