Galley PWS.docx

SECTION C PWS

GALLEY SERVICES

FOR U.S. NAVAL HOSPITAL GUAM

GUAM, MARIANAS ISLANDS (M.I.)

Galley

Table of Contents

SECTION A PWS

Galley

cleaning of equipment and maintaining proper sanitation of the galley facilities.

Galley

aroma and flavor to induce appetite and consumption.

Supply All non-perishable goods to support the operation of a galley including, but not limited to, food preparation supplies, cleaning supplies, and office supplies.

fixed period of time, e.g., 35 days.

General Messes.

other similar items.

washing mess gear, and disposing of food waste.

Materials Communications, Emergency Response Information, and Training Requirements.

U.S. Department of Agriculture and Health and Human Services and DoD Menu Standards.

vegetables, are served.

effectiveness indicates food items posted on the menu are available from the first patron to the last patron within a particular meal period.

forks, and coffee cups.

General Messes, The New Professional Chef, and The Art and Science of Culinary Preparation.

preventive medicine and environmental health to Navy and Marine Corps activities.

Galley

(RIK)

Prepared meals being served to entitled personnel such as regular and reserve enlisted personnel and others listed in Part A, Chapter 2 of NAVSUP P-486.

receipts, posting records, and fiscal accounting.

are served.

Kind (SIK) A Military Personnel Navy (MPN) funded program executed by the Navy Exchange Service Command (NEXCOM) to purchases Navy subsistence.

requirements for DoD installations.

services.

Training Specific certification and training requirements are addressed as follows.

5010, Food Safety.

as well as be trained on portion control and regular/therapeutic diets.

Certification All Contractor chefs are preferred to have Certified Culinarian certification issued by the American Culinary Federation

request.

All employees shall wear Contractor-provided uniforms, including shirts and/or blouses which are clearly distinguishable from other facility uniforms currently in use. The uniform shall be worn as designed by the uniform manufacturer.

Sandals or other open-toed shoes shall NOT be worn.

practices as specified by Section 2-3 and Section 2-4, Chapter 1 of NAVMED P- 5010.

Permits The Contractor shall maintain food service licensing and permit requirements per local laws and regulations.

Health (NAVOSH) Program Manual.

GFE is provided in Section J-1300000-10.

Galley

meet reporting requirements specified herein are provided in Appendix C of NAVSUP P-486.

Item Performance requirement

Performance Objective Performance Standard

for NAVHOSP.

1. Sufficient servings of nutritious and acceptable meals are provided within specified meal periods.

2. Galley operations comply with specified procedural, health, and sanitation standards.

3. No validated customer complaints.

Performance Requirement

Performance Objective Performance Standard

2. No interruption in services.

2. No occurrence of interruption to cycle menu execution due to subsistence supply logistic issues.

3. No validated customer complaints.

2. No validated customer complaints.

Performance Requirement

Performance Objective Performance Standard

10110.5 Encl (2) for both spot and wall-to-wall inventory inspections.

2. Damaged items are removed from service.

3. No validated customer complaints.

Performance Requirement

Performance Objective Performance Standard

2. Based on The Nutrition Management Monthly Performance and Reimbursement Analysis Report BUMED 10110-2 meet feeding and financial goals: at Meal Day Costs, at BDFA and prevent over/under issue.

2. Emergency maintenance requests are forwarded within 30 minutes.

3. All work orders, follow- up, and resolutions must be documented with date and time of response.

2. Training is conducted as scheduled.

3. Personnel training plans are available for review.

The Contractor shall ensure facility and

1. Maintain compliance with TJC, Preventive Medicine and Army Vet standards 100% of the time.

Performance Requirement

Performance Objective Performance Standard

2. Daily meal preparation and serving processes are executed without supply issues due to Contractor negligence.

3. No validated customer complaints.

The Contractor shall provide menus that meet or exceed nutritious and dietary requirements of DoD Menu Standards, NAVSUP P-486,

1. Cycle menu planning is performed as specified.

2. 98% of all meals meet Department of Defense (DoD) Joint Nutrition Standards.

Performance Requirement

Performance Objective Performance Standard

2. Strict compliance with recipes for therapeutic diet orders.

3. Meals are available within specified meal

Performance Requirement

Performance Objective Performance Standard periods and number of portions prepared meets meal demand.

4. Required temperature logs are maintained daily.

5. Customer Survey Monthly Summary indicates average scores for meal planning related components that are consistent with the specified COL.

2. Main line and speedline entrees are available to meet meal demand within specified meal periods.

3. No validated customer complaints.

2. The Contractor shall ensure meals are in compliance with the Nutrition Care Manual for hospital inpatients.

Wait time in line for a meal must not exceed five

(5) minutes after passing the headcounter’s station.

(COL 3).

Performance Requirement

Performance Objective Performance Standard

2. Meal preparation of therapeutic diet and nutrition formulas are met or exceed all hospital guidelines, regulations specified standards and approved cycle menu and recipes are followed.

3. Meals are provided on time 100% of the time.

4. No validated customer complaints.

Snacks The Contractor shall ensure inpatients are

1. Snacks are always available when requested.

Performance Requirement

Performance Standard provided with snacks that meet or exceed hospital guidelines, standards and regulations.

2. No noted instances of shortages.

2. All temperatures should meet standards and regulations.

2. No instances of unsanitary conditions.

3. Average wait time for patrons to reach serving lines is consistent with the specified COL.

4. Customer Survey Monthly Summary indicates average scores for meal services related

Performance Requirement

Performance Standard components that are consistent with the specified COL.

5. No validated customer complaints.

Para.2201 and 2202.

2. No unauthorized personnel allowed in the dining facility due to Contractor negligence.

3. Collected payment reconciles with number of paying patrons for each meal period. Any receipt discrepancy is resolved within 24 hours of transaction.

4. All NAVSUP forms are accurate and submitted within the specified time.

5. No validated customer complaints.

Performance Requirement

Performance Standard

2. Menu effectiveness is consistent with the specified COL.

3. No noted shortages of food, beverages or galley products.

4. Full compliance with NAVMED P-5010.

5. No validated customer complaints.

The Contractor shall ensure sanitary conditions at NAVHOSP galley are maintained at all times.

1. Dining area set-up properly completed prior to each specified meal period.

2. All containers are clean with sufficient supplies continuously available.

3. Preventative Medicine reports are within sanitation guidelines and corrected in required time frame.

4. No instances of unsanitary conditions.

5. Full compliance with NAVMED P-5010.

Performance Requirement

Performance Standard

6. No validated customer complaints.

2. Neat appearance of the dining area is continuously maintained during and after meal periods.

3. Dining spaces are cleaned and ready to be occupied by new patrons within two (2) minutes of being vacated.

4. No validated customer complaints.

The Contractor shall ensure ward areas are cleared of all food services items after each meal.

1. Therapeutic meals delivered to inpatients are consistent with the diet roster and/or dietitian at all time.

2. Meals are delivered with the correct temperature and in sanitary condition at all time.

3. Meals delivered shall include the patients’ selected meal choices that are in compliance with the therapeutic diet order.

Performance Requirement

Performance Standard

4. All food service items are removed from the ward within sixty (60) minutes after each meal period.

2. No validated customer complaints.

The Contractor shall ensure all food service items are cleaned and sanitized to required standards and are ready for reuse.

1. Full compliance with NAVMED P-5010.

2. Sanitation related violations reported during each PMA inspection are not in excess of the specified COL.

3. Mess gear is cleaned, sanitized, and stored per specified procedures and standards.

4. Clean and sanitary dining ware and utensils are continuously available during meal periods.

5. Customer Survey Monthly Summary indicates average scores for scullery operation related components that are consistent with the specified COL.

dining ware and utensils are available.

1. Scullery machines and equipment are operated as specified and monitoring log of operating temperatures is accurate and current.

Performance Requirement

Performance Standard

2. No shortage of dining ware and utensils during meal periods.

cleaned, sanitized, and stored.

1. Cookware and serving utensils are cleaned, sanitized, and stored after each use as specified.

2. Sanitation related violations reported during each PMA inspection are not in excess of the specified COL.

3. The facility is clean, sanitary, and sightly consistent with the specified housekeeping standards.

4. Customer Survey Monthly Summary indicates average scores for housekeeping and sanitation services related components that are consistent with the specified COL.

2. Cleanliness and sanitary condition of food equipment is maintained during the meal preparation and serving process.

Performance Requirement

Performance Objective Performance Standard

2. All specified functional areas of the facility are cleaned, sanitized, and stocked per the Contractor’s schedule.

3. Minor cleaning tasks are completed within two

(2) minutes after receipt of notification.

No validated customer complaints.

Areas: Six (6) administrative offices, storm rooms, scullery, galley meal preparation spaces, walk-in reefers, galley serving area and dining room (mess decks).

1. Floors are cleaned per the Contractor’s schedule.

2. Minor floor cleaning tasks are completed within two minutes after receipt of notification.

3. No validated customer complaints.

2. Waste is removed to maintain a sanitary, odor free and pest free facility.

Performance Requirement

Performance Objective Performance Standard

The Contractor shall prepare NAVHOSP Galley facilities and operations to meet Condition of Readiness (COR) IV, III and II requirements of the JTREGMARIANASI NST 3440.17 and USNHGUAMINST 3440.1C Annex I Appendix 5 and 6, Financial Consideration and Food Service Support.

1. Galley down time is minimized.

2. Minimal disruption to operation occurred during preparation.

3. Material, equipment and facilities are protected.

2. Damage to and loss of materials, equipment and facilities are minimized.

Performance Requirement

Performance Objective Performance Standard

2. Operations are restored in the most economical and expedient manner.

Galley

accordance with Section H or on a task order in accordance with the PROCEDURES FOR ISSUING ORDERS clause in Section G. The order will specify the exact locations and types of work to be accomplished. The period of performance will be specified in each order.

Refer to Non-Recurring ELINs for task listings, descriptions, and related requirements. All periods of performance are measured from issue date of order to acceptance of the work. Performance standards for Non-Recurring work will be the same as those in Spec Item 3 where applicable.

order.

Response Same as Spec Item

Recovery Same as Spec Item

Galley

SECTION B: DELIVERIES OR PERFORMANCE

Deliverable Title

Date (s) of Submission Distribution

Frequency

Original Copies (including original)

initial

submittal, KO then as requested

each month

Ledger (Wall to

Wall)

Ledger (Spot

Inventory)

Inventory Record

Monthly

Monthly performance and

Reimbursement

Analysis Report

Inspections for

NAVHOSP

after contract award and 30 days prior to the end of each calendar year

SECTION B PWS

Annex/ Spec Item

Deliverable Title

Date (s) of Submission Distribution

Frequency

Original Copies (including original)

Preparation

Worksheet

Signature Record

Recapitulation of

Meal Record

Payment Book

Mess Summary

Document

Services

after contract award

Deliverables Form Preparation Instructions

Deliverable Title: Certification, Training and Licenses

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Submit a copy of the summary report via email to KO for Government review and comment.

Deliverables Form Preparation Instructions

Deliverable Title: Consumable Supply Invoices

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: NAVSUP Form 335 Subsistence Ledger (Wall to Wall)

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: NAVSUP Form 335 Subsistence Ledger (Spot Inventory)

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Equipment and Mess Gear Inventory Record

Form Attachment No.: J-1300000-08

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Replacement Request for Damaged Items

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Nutrition Management Fiscal Year Report

Form Attachment No.: J-1300000-06

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Nutrition Management Monthly Performance and Reimbursement Analysis Report

Form Attachment No.: J-1300000-11 and J-1300000-12

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Annual Training Plan

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

NUMBER

DATE

PREPARED BY: REVIEWED BY:

APPROVED BY:

REPORT OF TRAINING ATTENDANCE

NAME:

RECORD OF TRAINING ACCOMPLISHMENTS INCLUDING ALL GMT’S

Deliverables Form Preparation Instructions

Deliverable Title: After Action Reports Following JCAHO and IG Inspections for NAVHOSP

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

DATE

MEMORANDUM

From:

SUBJ: Action Reports Following TJC Inspections for NAVHOSP, Month/Year

1) State TJC discrepancy/(ies)

2) State how discrepancy will be resolved and/or process improvement initiative

3) State time frame in which the discrepancy will be completed

Deliverables Form Preparation Instructions

Deliverable Title: Cycle Menu

Form Attachment No.: J-1300000-07

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: NAVSUP Form 1090 Food Preparation Worksheet

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Test Trays

Form Attachment No.: J-1300000-13

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: NAVSUP Form 1291 Meal Signature Record

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: NAVSUP Form 1292 Recapitulation of Meal Record

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: DoD Form 1544 Cash Meal Payment Book

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Form 470 Cash Receipt Book

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: DoD Form 1131 Cash Collection Voucher

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: NAVSUP Form 1359 General Mess Summary Document

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Customer Survey Monthly Summary

Form Attachment No.: J-1300000-04

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Schedule for Housekeeping and Sanitation Services

Form Attachment No.: J-1300000-09

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

Deliverables Form Preparation Instructions

Deliverable Title: Contingency Plan

Form Attachment No.: N/A

Government Approval Required: X Yes No

Instructions:

The report shall be prepared using Microsoft Office Word software or delivered on the appropriate form.

SECTION C

DOCUMENTS, EXHIBITS, AND OTHER ATTACHMENTS TABLE OF CONTENTS

SECTION C PWS 1300000

ATTACHMENT 1

LISTING OF REFERENCES, INSTRUCTIONS, AND DIRECTIVES

Culinary and Hospitality Industry Publications Services The Art and Science of Culinary Preparation

U.S. Department of Agriculture and Health and Human Services Dietary Guidelines for Americans

ATTACHMENT 2

COMMON OUTPUT LEVEL STANDARDS

Average wait time to reach the serving lines per meal

Less than 3 minutes

3 - 5 minutes

5 - 7 minutes

More than 7 minutes

Menu net effectiveness per meal

Greater than 90%

80% - 89%

70% - 79%

Less than 70%

Customer survey (all components on a 4 point scale per month)

Greater than 3.5

2.6 - 3.5

1.9 - 2.5

Less than 1.9

Sanitation rating per PMA inspection

Pass with less than 2 critical hits

Pass with 3 to 4 critical hits

Pass with 5 to 7 critical hits

Fail with 8 or more critical hits

Housekeeping and sanitation scheduled tasking completed per month

Greater than 95%

90% - 94%

85% - 89%

Less than 85%

ATTACHMENT 3

CUSTOMER SURVEY FORM

CUSTOMER SURVEY

GALLEY LOCATION: DATE: TIME:

[On a scale from 1 to 4, with 1 being the lowest rating and 4 being the highest rating]

(1) Promptness of the sign-in process and/or cash transaction [ 1 ] [ 2 ] [ 3 ] [ 4 ]

(2) Availability of food items that are specified on the daily menu [ 1 ] [ 2 ] [ 3 ] [ 4 ]

(7) Appearance and sanitary conditions of the facility [ 1 ] [ 2 ] [ 3 ] [ 4 ]

(8) Quality of service from galley attendants [ 1 ] [ 2 ] [ 3 ] [ 4 ]

ATTACHMENT 4

CUSTOMER SURVEY MONTHLY SUMMARY

CUSTOMER SURVEY MONTHLY SUMMARY

GALLEY LOCATION: MONTH: YEAR:

(2) Availability of food items that are specified on the daily menu [ ]

(5) Availability of dining ware and utensils [ ]

(8) Quality of service from galley attendants [ ]

ATTACHMENT 5

GALLEY FLOOR PLAN

SEE ATTACHEMENT 5

ATTACHMENT 5

DINING

SERVING

GALLEY

FLOOR PLAN, 1ST FLOOR, GALLEY AND DINING FACILITY

PROJECT TITLE and LOCATION

BUMED BLDG 50

NavHos

ATTACHMENT 6

HISTORICAL MEAL DEMAND DATA

U.S. NAVAL HOSPITAL

Nutrition Management Fiscal Year Report

SEE ATTACHMENT 6

Attachment 6

SECTION C PWS

US NAVAL HOSPITAL GUAM

As of DECEMBER, 2021

UIC: 68096

Days

Meal Collections

SIK

Bed Day Blood Donors

APU/SDS

Adm Cts Other Outpts Except

Meal

orkload

MONTH

October November Thanksgiving Meal December Christmas Meal January February March April May June July August September

$ 6,211.62

$ 4,182.70

$ 4,823.80

$ 4,056.80

$ 4,211.85

$ 6,597.51

$ 6,753.22

$ 5,733.73

$ 6,193.52

$ 5,316.70

$ 6,467.32

$ 6,450.00

Total Number of Food Service Facilities1

B. Number of Meal�Days Fed54691

Number of Meals Fed (by Type):

Breakfast23291 28025

Brunch Lunch Dinner Supper Night Meal Holiday Snack

C2 Operating Expenses

US NAVAL HOSPITAL GUAM

As of DECEMBER 2022

UIC: 68096

Bed Day Blood Donors

APU/SDS

Other Outpts Except

Meal

orkload

MONTH

October November Thanksgiving Meal December Christmas Meal January February

September

$ 4,424.05

$ 4,360.55

$ 4,333.65

$ 3,924.60

$ 4,007.15

$ 4,774.00

$ 4,271.80

$ 4,092.80

$ 4,050.65

$ 3,879.75

$ 5,195.15

$ 4,773.65

A. Total Number of Food Service Facilities1

B. Number of Meal�Days Fed55919

Breakfast24278 24866 26906

C. Amount of Meal Collections:

SECTION 6 PWS

Attachment 6

US NAVAL HOSPITAL GUAM

As of DECEMBER 2023

UIC: 68096

Bed Day Blood Donors

APU/SDS

Other Outpts Except

Meal

orkload

MONTH

October November Thanksgiving Meal December Christmas Meal January February

September

$ 32,683.07

$ 4,360.55

$ 5,079.60

$ 4,656.65

$ 5,130.10

$ 5,987.55

$ 5,008.50

$ 6,699.80

$ 6,647.50

$ 5,194.65

$ 6,238.05

$ 5,274.20

92960.22

A. Total Number of Food Service Facilities1

B. Number of Meal�Days Fed61264

Breakfast26544 29206

C. Amount of Meal Collections:

SECTION 6 PWS

ATTACHMENT 7

SAMPLE CYCLE MENU

U.S. NAVAL HOSPITAL, GUAM

SEE ATTACHMENT 7

Waffle(15g CHO) Low Fat Yogurt(12g CHO) Juice(15g CHO) Fruit Cocktail(15g CHO) Scrambled Eggs(1oz) / Scrambled Egg Whites•(1oz) Hard Boiled Egg(1ea.)

Spam(1ea) / Bacon(2 ea) Margarine / Jelly / Cream Cheese / Peanut Butter / Syrup

Coffee- (REG/DECAF) Creamer/White Sugar/Equal Unsweetened Tea (HOT/COLD)(REG/DECAF)

Milk (Low-fat/Skim)(Chocolate//Plain)(12g CHO)

ADA: Starch: , Fruit: Milk: Meat: , Vegetable: , Fat:

Chicken Noodle Soup(9g CHO) Mexican Baked Chicken 3oz(1g CHO) Garlic Roasted Pot.(15g CHO White/Brown Rice(15g CHO)

Dessert(15g CHO) Sugar Free Jell-O Coffee- (REG/DECAF) Creamer/White Sugar/Equal Unsweetened Tea (HOT/COLD)(REG/DECAF) Sugar Free Crystal Light Milk (Low-fat/Skim)(Chocolate//Plain)(12g CHO)

ADA: Starch: , Fruit: Milk: Meat: , Vegetable: , Fat:

Soup of the day El Rancho Stew 3oz(20g CHO)

White/Brown Rice(15g CHO) Mashed Potatoes(15g CHO) White Bread(15gCHO) Wheat Bread(15g CHO) Dinner Roll(15g CHO) Roast Beef Sandwich(30g CHO) Tuna Sandwich(30g CHO) Lettuce/Tomato/Cheese/Onions Brussels Sprouts(-g CHO) Cauliflower(-g CHO) Tossed Salad with dressing(14g CHO) Fresh Fruit(15g CHO) Juice(15g CHO) Peaches(15g CHO) Margarine/ Peanut Butter/ Mustard/ Ketchup/Mayonnaise Coffee- (REG/DECAF) Creamer/White Sugar/Equal Unsweetened Tea (HOT/COLD)(REG/DECAF) Sugar Free Crystal Light Milk (Low-fat/Skim)(Chocolate//Plain)(12g CHO)

SECTION C PWS

Attachment 7 Nutrition Management Department, U.S. Naval Hospital Guam Please circle your choices. If you do not circle your choices, items marked with a • will be provided. •Heart Smart Entree

Attachment 7

BREAKFAST

SUNDAY(1) REGULAR / CARB - CHO CONTROLLED CARDIAC / OTHER:

LUNCH

SUNDAY(1) REGULAR / CARB - CHO CONTROLLED CARDIAC / OTHER:

DINNER

SUNDAY(1) REGULAR / CARB - CHO CONTROLLED

CARDIAC / OTHER:

NAME: Ward:

NAME:

Ward:

NAME: Ward:

1/12 wm

ADA: Starch: , Fruit: Milk: Meat: , Vegetable: , Fat:

Belgian Waffle(15g CHO) Low Fat Yogurt(12g CHO) Juice(15g CHO) Fruit Cocktail(15g CHO)

Scrambled Eggs(1oz) / Scrambled Egg Whites•(1oz) Hard Boiled Egg(1ea.)

Corned Beef Hash(3G CHO) / Bacon(2 ea) Margarine / Jelly / Cream Cheese / Peanut Butter / Syrup

Coffee- (REG/DECAF) Creamer/White Sugar/Equal Unsweetened Tea (HOT/COLD)(REG/DECAF) Milk (Low-fat/Skim)(Chocolate//Plain)(12g CHO)

ADA: Starch: , Fruit: Milk: Meat: , Vegetable: , Fat:

Cream of Broccoli(14g CHO) Sauerbraten 3oz (19g CHO) Lemon Baked Fish 3oz (-g CHO) White/Brown Rice(15g CHO) Mashed Potatoes(15g CHO)

Coffee- (REG/DECAF) Creamer/White Sugar/Equal Unsweetened Tea (HOT/COLD)(REG/DECAF) Sugar Free Crystal…