Nutrition intake and follow-up sheet
Page one is the first visit: goals, health, habits and the starting measurements. Page two is the follow-up sheet, one row per visit, with the change since the last visit and since the start.
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- Word · English.docx · 39 KB
- PDF · English.pdf · 226 KB
- Word · Arabic.docx · 39 KB
- PDF · Arabic.pdf · 77 KB
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What is in the file
| Goals and health | Goals ticked and in the patient’s words, a measurable target, medical conditions, medications and supplements, food allergies, intolerances and foods avoided. |
|---|---|
| Habits | Activity level, exercise, sleep, working hours and a typical day of eating from breakfast to drinks. |
| Starting measurements | Weight, height, BMI, waist, body fat %, muscle mass, visceral fat and water %, plus recent labs if the patient has them. |
| Follow-up sheet | A row per visit with the same measurements, change since last visit and since the start, then adherence from 1 to 5, notes and the next target. |
How to use it
Add your letterhead
Open the Word file and put your logo and clinic details in the header box.
Fill page one at the first visit
Take the starting measurements on the same scale you will use later.
Add a row each visit
Write the new weight and work out the change from the last row and from the start.
Agree the next target
Rate adherence with the patient and write one target for the next visit.
Who it is for
Dietitians and nutrition clinics, and weight management or diabetes programmes inside a larger clinic. It works with a body composition scale or with weight and waist alone: leave the other columns blank.
Questions
Do I need a body composition scale?
No. Weight, height, BMI and waist work with ordinary equipment. The body fat, muscle, visceral fat and water columns are there if your scale measures them.
Why rate adherence?
It separates “the plan did not work” from “the plan was not followed”, which changes what you do next. The patient rates it with you.
Does it include a meal plan?
No. It records the starting point and the follow-up. The plan itself is yours to write for each patient.
How many visits does page two hold?
Ten rows. Print another page two when they are used up.
Every visit plotted, every package tracked
In Medicolize the measurements are recorded at each visit and the change is worked out for you, and a follow-up package shows how many visits are used and left. Thirty minutes on your own clinic.