C1 RENAL YC26.docx

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Sunday – Breakfast Renal Dialysis or Renal Pre-Dialysis(1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Sunday - Lunch Renal Dialysis or Renal Pre-Dialysis(1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Sunday - Dinner Renal Dialysis or Renal Pre-Dialysis(1)

Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level.

g = grams of Carbohydrate. 1 cup fluid at breakfast allowed. Total carbohydrates _______ g.

Grains (15g)

□ Arroz caldo – ½ cup

□ Grits – ½ cup

□ Oatmeal – ½ cup

□ Assorted Cold Cereal

□ English Muffin (23g)

□ White toast __ slice(s) (15g/sl)

□ French toast (17g/sl)

Toppings / Condiments

□ Jam – regular (10g Carb)

□ Jam – sugar free (1Tbsp = 5g Carb)

□ Syrup – regular (1.5oz = 25g Carb)

□ Syrup – sugar free (2Tbsp = 5g Carb)

□ Brown Sugar (1tsp unpacked= 3g Carb)

□ Raisins (1Tbsp = 11g Carb)

□ Juice: Apple

□ Canned Fruit: Fruit cocktail, pears, peaches, applesauce, mandarin oranges

□ Fresh Fruit: apple

□ Hard-boiled egg

□ Scrambled eggs OR Egg Whites

□ Low-fat milk (4oz) (6g)

□ Whole milk (4oz) (6g)

□ Unflavored Soymilk (4oz) (6g)

□ Brewed hot or cold Black Tea

□ SugarSub, Non-Dairy creamer(1g)

□ Sugar Free Lemonade

Condiments:

Sugar (3g/pkt), Butter, Pepper, Mrs. Dash

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

Soup of the Day (Choose 1)

□ Chicken, Beef or Vegetable Broth ½ cup fluid Main Entrees (Choose 1)

□ Dijon Tuscan chicken

□ Baked Fish with Lemon and Garlic Butter

□ Arroz caldo (15g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Grilled Chicken Breast

□ Egg salad

□ Turkey

□ Lettuce, Onion

□ On white bread or bun (15g/slice)

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

Vegetables

□ Mixed Vegetables (10g)

□ Side salad (3g)

½ cup total fluid allowed at lunch

Beverages

□ Coffee (Decaf/Regular)

□ Brewed hot or cold Black Tea

□ Sugar Sub, Non-dairy creamer (1g)

□ Sugar Free Lemonade

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

□ Fresh Fruit: apple

Butter, Mayonnaise, Mustard, Pepper, Mrs. Dash, Sugar (3g/pkt)

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable.

Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Baked Salmon with Herb Vinaigrette

□ Tofu OR Chicken stir-fry (17g)

□ Arroz caldo (15g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Chicken

□ Egg salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

□ Steamed Peas and Carrots (11g)

□ Cauliflower (5g)

½ cup total fluid allowed at dinner

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Monday – Breakfast Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Monday – Lunch Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Monday – Dinner Renal Dialysis or Renal Pre-Dialysis (1)

Please select your menu. Substitutions will be made when a food item is unavailable.

Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. 1 cup fluid at breakfast allowed. Total carbohydrates _______ g.

□ Arroz caldo – ½ cup

□ Grits – ½ cup

□ Oatmeal – ½ cup

□ Assorted Cold Cereal

□ English Muffin (23g)

□ White toast __ slice(s) (15g/sl)

□ Jam – regular (10g Carb)

□ Jam – sugar free (1Tbsp = 5g Carb)

□ Syrup – regular (1.5oz = 25g Carb)

□ Syrup – sugar free (2Tbsp = 5g Carb)

□ Brown Sugar (1tsp unpacked= 3g Carb)

□ French toast (17g/sl)

□ Juice: Apple

□ Canned Fruit: Fruit cocktail, pears, peaches, applesauce, mandarin oranges

□ Fresh Fruit: apple

□ Hard-boiled egg

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

Soup of the Day (Choose 1)

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Arroz caldo (15g)

Main Entrees (Choose 1)

□ Baked fish w/lemon

□ Chicken a la king (15g)

□ Hamburger

□ Grilled Chicken Breast

□ Egg salad

□ Tuna salad

□ Turkey

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

□ Steamed Carrots (8g)

½ cup total fluid allowed at lunch

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Baked fish w/ Garlic Butter & Lemon

□ Herb Baked Chicken

□ Arroz caldo (15g)

□ Tofu OR Chicken stir-fry (17g)

□ Hamburger

□ Chicken

□ Egg salad

□ Tuna salad

□ Turkey

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

Vegetables

□ Calico cabbage (6g)

□ Steamed Carrots (8g)

½ cup total fluid allowed at dinner

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Tuesday – Breakfast Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Tuesday – Lunch Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Tuesday – Dinner Renal Dialysis or Renal Pre-Dialysis (1)

Please select your menu. Substitutions will be made when a food item is unavailable.

Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. 1 cup fluid at breakfast allowed. Total carbohydrates _______ g.

Grains (15g)

□ Arroz caldo – ½ cup

□ Grits – ½ cup

□ Oatmeal – ½ cup

□ Assorted cereal

□ English Muffin (23g)

□ White toast __ slice(s) (15g/sl) □ □ Buttermilk pancakes – 2pc (23g)

Toppings / Condiments

□ Jam – regular (10g Carb)

□ Syrup – regular (1.5oz = 25g Carb)

□ Syrup – sugar free (2Tbsp = 5g Carb)

□ Juice: Apple

□ Canned Fruit: Fruit cocktail, pears, peaches, applesauce, mandarin oranges

□ Fresh Fruit: apple

□ Hard-boiled egg

□ Low-fat milk (4oz) (6g)

□ Whole milk (4oz) (6g)

□ Brewed hot or cold Black Tea

□ SugarSub, Non-Dairy creamer(1g)

□ Sugar Free Lemonade

Sugar (3g/pkt), Butter, Pepper, Mrs. Dash, Sugar (3g/pkt)

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

Soup of the Day (Choose 1)

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Arroz caldo (15g)

Main Entrees (Choose 1)

□ Cilantro lime fish

□ Mexican pepper steak (11g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Tuna salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

Vegetables

□ Roasted Carrots (6g)

½ cup total fluid allowed at lunch

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Baked Salmon w/ herb vinaigrette

□ Herb baked Chicken

□ Arroz caldo (15g)

□ Tofu OR Chicken stir-fry (17g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Tuna salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

□ Mixed Vegetables (10g)

□ Steamed Broccoli (2g)

½ cup total fluid allowed at dinner

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Butter, Mayonnaise, Mustard, Pepper, Mrs. Dash, Sugar (3g/pkt), Wednesday – Breakfast Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Wednesday – Lunch Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Wednesday – Dinner Renal Dialysis or Renal Pre-Dialysis (1)

Please select your menu. Substitutions will be made when a food item is unavailable.

Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. 1 cup fluid at breakfast allowed. Total carbohydrates _______ g.

Grains (15g)

□ Grits – ½ cup

□ Oatmeal – ½ cup

□ Assorted Cold Cereal

□ English Muffin (23g)

□ White toast __ slice(s) (15g/sl)

Toppings / Condiments

□ Jam – regular (10g Carb)

□ Syrup – regular (1.5oz = 25g Carb)

□ Syrup – sugar free (2Tbsp = 5g Carb)

□ Raisins (1Tbsp = 11g Carb)

□ Hard-boiled egg

□ Juice: Apple

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

□ Low-fat milk (4oz) (6g)

□ Whole milk (4oz) (6g)

□ Brewed hot or cold Black Tea

□ SugarSub, Non-Dairy creamer(1g)

□ Sugar Free Lemonade

Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Arroz caldo (15g)

□ Teriyaki chicken (5g)

□ Honey spice rubbed salmon

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Tuna salad

□ Turkey

Sides (Choose some of each)

Starches

□ Dinner roll (15g)

□ White rice (15g)

Vegetables

□ Steamed broccoli (2g)

□ Vegetable medley (11g)

½ cup total fluid allowed at lunch

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Sesame Chicken (7g)

□ Baked Fish with Lemon and Garlic Butter

□ Tofu OR Chicken stir-fry (15g)

□ Arroz caldo (15g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Tuna salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

Vegetables

□ Roasted okra (5g)

½ cup total fluid allowed at dinner

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Thursday – Breakfast Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Thursday - Lunch Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Thursday - Dinner Renal Dialysis or Renal Pre-Dialysis (1)

Please select your menu. Substitutions will be made when a food item is unavailable.

Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. 1 cup fluid at breakfast allowed. Total carbohydrates _______ g.

Grains (15g)

Toppings / Condiments

□ Jam – regular (10g Carb)

□ Jam – sugar free (1Tbsp = 5g Carb)

□ Syrup – regular (1.5oz = 25g Carb)

□ Syrup – sugar free (2Tbsp = 5g Carb)

□ Brown Sugar (1tsp unpacked= 3g Carb)

□ Raisins (1Tbsp = 11g Carb)

□ Grits – ½ cup

□ Oatmeal – ½ cup

□ Assorted Cold Cereal

□ English Muffin (23g)

□ White toast __ slice(s) (15g/sl)

□ Buttermilk pancakes – 2pc (23g)

□ Canned Fruit: Fruit cocktail, pears, peaches, applesauce, mandarin oranges

□ Scrambled eggs OR Egg Whites

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Rosemary pork tenderloin

□ Herb baked chicken

□ Arroz caldo (15g)

□ Hamburger

□ Grilled Chicken Breast

□ Egg salad

□ Tuna salad

□ Turkey

□ Lettuce, Onion

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

Vegetables

□ Broccoli salad (8g)

□ Side salad (<5)

□ Green beans (5g)

½ cup total fluid allowed at lunch

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Butter, Mayonnaise, Mustard, Pepper, Mrs. Dash, Sugar (3g/pkt), Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Caribbean spiced fish (2g)

□ Italian herb baked chicken

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Tuna salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

Vegetables

□ Oriental stir-fry cabbage (7g)

□ Baby Carrots (8g)

□ Side salad (<5)

½ cup total fluid allowed at dinner

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Friday – Breakfast Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Friday – Lunch Renal Dialysis or Renal Pre-Dialysis (1)

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Friday - Dinner Renal Dialysis or Renal Pre-Dialysis (1)

Please select your menu. Substitutions will be made when a food item is unavailable.

Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. 1 cup fluid at breakfast allowed. Total carbohydrates _______ g.

Grains (15g)

Toppings / Condiments

□ Jam – regular (10g Carb)

□ Jam – sugar free (1Tbsp = 5g Carb)

□ Syrup – regular (1.5oz = 25g Carb)

□ Syrup – sugar free (2Tbsp = 5g Carb)

□ Brown Sugar (1tsp unpacked= 3g Carb)

□ Raisins (1Tbsp = 11g Carb)

□ Grits – ½ cup

□ Oatmeal – ½ cup

□ Assorted Cold Cereal

□ English Muffin (23g)

□ White toast __ slice(s) (15g/sl)

□ Canned Fruit: Fruit cocktail, pears, peaches, applesauce, mandarin oranges

□ Scrambled eggs OR Egg Whites

□ Low-fat milk (4oz) (6g)

□ Whole milk (4oz) (6g)

□ Brewed hot or cold Black Tea

□ SugarSub, Non-Dairy creamer(1g)

□ Sugar Free Lemonade

Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Catch of the day

□ Arroz caldo (15g)

□ Hamburger

□ Grilled Chicken Breast

□ Egg salad

□ Tuna salad

□ Turkey

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

Vegetables

□ Roasted Broccoli and Carrots (5g)

½ cup total fluid allowed at lunch

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Baked Fish with Lemon and Garlic Butter

□ Tofu OR Chicken stir-fry (10g)

□ Arroz caldo (15g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Tuna salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

□ Normandy Blend (7g)

□ Peas and Carrots (11g)

½ cup total fluid allowed at dinner

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce

Saturday - Breakfast Renal Dialysis or Renal Pre-Dialysis

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Saturday - Lunch Renal Dialysis or Renal Pre-Dialysis

NUTRITION MANAGEMENT DEPARTMENT

US NAVAL HOSPITAL GUAM

Saturday - Dinner Renal Dialysis or Renal Pre-Dialysis

Please select your menu. Substitutions will be made when a food item is unavailable.

Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. 1 cup fluid at breakfast allowed. Total carbohydrates _______ g.

Grains (15g)

Toppings / Condiments

□ Jam – regular (10g Carb)

□ Jam – sugar free (1Tbsp = 5g Carb)

□ Syrup – regular (1.5oz = 25g Carb)

□ Syrup – sugar free (2Tbsp = 5g Carb)

□ Brown Sugar (1tsp unpacked= 3g Carb)

□ Raisins (1Tbsp = 11g Carb)

□ Grits – ½ cup

□ Oatmeal – ½ cup

□ Assorted Cold Cereal

□ English Muffin (23g)

□ White toast __ slice(s) (15g/sl)

□ Buttermilk pancakes – 2pc (23g)

□ Juice: Apple

□ Canned Fruit: Fruit cocktail, pears, peaches, applesauce, mandarin oranges

□ Fresh Fruit: apple

□ Hard-boiled egg

□ Low-fat milk (4oz) (6g)

□ Whole milk (4oz) (6g)

□ Brewed hot or cold Black Tea

□ SugarSub, Non-Dairy creamer(1g)

□ Sugar Free Lemonade

Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Baked Salmon w/ Herb Vinaigrette

□ Citrus herb chicken (6g)

□ Arroz caldo (15g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

□ Carrots (8g)

½ cup total fluid allowed at lunch

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges applesauce

Name: _________________________ Allergies: ________________ Ward: ICU / MSU / MBU Room #: _____ Diet office 344-7244 Please select your menu. Substitutions will be made when a food item is unavailable. Your menu may be adjusted based on your prescribed Calorie or Carbohydrate level. g = grams of Carbohydrate. Renal dialysis diets will have the standard amount of protein. Renal pre-dialysis diets will less protein, meaning smaller entrees. Total carbohydrates _______ g.

□ Chicken, Beef or Vegetable Broth ½ cup fluid

□ Baked Fish with Lemon and Garlic Butter

□ Tofu OR Chicken stir-fry (15g)

□ Arroz caldo (15g)

Alternate Entrees-Sandwiches

□ Hamburger

□ Egg salad

□ Turkey

Sides (Choose some of each)

Starches

□ White rice (15g)

□ White Dinner Roll (30g)

□ Green beans (4g)

□ Cauliflower (5g)

½ cup total fluid allowed at dinner

Beverages

□ Coffee (Decaf/Regular)

Fruits (15g)

□ Canned Fruit: Fruit cocktail, pears, peaches, mandarin oranges, applesauce