Patient Food & Drink Dislikes

Please Cross Out food & drinks that you do NOT like

Cereal: Oatmeal Cream of Wheat Cheerios Rice Krispies Frosted Mini Wheats
Raisin Bran Rice Chex Shredded Wheat Corn Flakes Kix Apple Cinnamon Cheerios
Cinnamon Chex
Juice: Apple Orange Cranberry Grape Pineapple

Dairy: 2% Milk Skim Milk Yogurt American Cheese Mozzarella Cheese

Swiss Provolone Cheddar Cottage Cheese Feta Parmesan

Entrée: Beef Taco Quesadilla Meatballs Meatloaf Hamburger Sliced Beef Cubed Beef*
Salisbury Steak Shepherd’s Pie Sausage Bacon Pulled Pork Roast Pork Ham
Hot Dog Kielbasa Salmon Shellfish Tuna Breaded Fish Baked Fish Boneless Chicken
Chicken with Bone Turkey Pizza Alfredo Tortellini Cheese Ravioli Baked Ziti
Egg Salad Macaroni & Cheese Salad Meal*
Omelet Hard Boiled Egg Scrambled Eggs Pancakes French Toast Breakfast Sandwich*
Waffles Spinach & Egg Pizza Egg & Sausage Bake
Starch: Pasta/Noodles/Spaghetti Stuffing Refried Beans Kidney Beans Chick Peas
Baked Beans White Rice Lemon Herb Rice Spanish Rice Rice Pilaf Home Fries
Potatoes: Mashed Oven Roasted Baked Potato Sweet Potato Oven Fries Potato Puffs
Bread: White Whole Grain Wheat Rye/Dark Rye Garlic Bread Pita Bread
Dinner Roll Biscuit English Muffin Muffins (Blueberry etc.) Bread Stick Corn Bread

Vegetables: Summer Squash Butternut Squash Cooked Onions Raw Onions Brussel Sprouts
Cooked Peppers Raw Peppers Raw Tomatoes Green Beans Wax Beans Corn Celery
Beets Broccoli Carrots Tomato Sauce Mushrooms Cauliflower Zucchini
Peas Salad Spinach Cucumber Olives Coleslaw Mixed Vegetables*
Fresh Fruit: Red Apple Banana Cantaloupe Grapes Orange Honey Dew
Watermelon Strawberries Blueberries Granny Smith Apple
Canned Fruit: Applesauce Peaches Pears Mandarin Oranges Fruit Cocktail Pineapple Chunks

Other: Gravy Mayo Mustard Ketchup Relish Salsa Sour Cream

Cake Pudding Cookies/Bars Ice Cream Sherbet Chocolate Pie Soup
Cranberry Sauce BBQ Sauce Frozen Yogurt Teriyaki Sauce Tartar Sauce Jelly Raisins

Food Allergies: _____________________________________________________________

Special Request: ____________________________________________________________

*please see description/options on back

Patient Name: ____________________________

Unit:________________________
MHW Name & Date:__________________________
R/R May 2020
Salad Meals Include:
BBQ Chicken Salad
Chicken Caesar Salad
Turkey BLT Salad
Beef Taco Salad
Greek Salad w/ Chicken

Cooked Mixed Vegetables Include:

Riviera Blend (Green Beans, Yellow Beans, Carrots)
Sicilian Blend (Green Beans, Carrots, Cauliflower, Onions, Peppers)
Normandy Blend (Broccoli, Cauliflower, Carrots, Zucchini, Summer Squash)
Italian Blend (Green Beans, Carrots, Zucchini, Cauliflower, Peppers, Lima Beans)
Scandinavian Blend (Peas, Zucchini, Green Beans, Carrots, Onion)
California Blend (Broccoli, Cauliflower, Carrots)
Key Largo Blend (Carrots, Peppers, Green Beans)
Summer Mix (Zucchini, Summer Squash, Peppers)
Winter Mix (Broccoli & Cauliflower)
Prince William Blend (Broccoli, Carrots, Green Beans, Red Peppers)
Mediterranean Blend (Squash, Zucchini, Carrots, Green Beans, Onions, Peppers, Garlic)
Pacific Blend (Sugar Snap Peas, Carrots, Broccoli)
German Blend (Green Beans, Wax Beans, Carrots)

Breakfast Sandwiches Include:

Sausage, Egg & Cheese on English
Egg & Cheese on English
Egg & Cheese on Biscuit

Cubed Beef:
Beef Stroganoff
Beef Stew