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Direction: To be filled up by the Nursing Service at least 2 – 3 hours before meals. Date:03/24/2022

Rm NAME OF PATIENT AGE S Ht DOB Wt. DIAGNOSIS DIET PRESCRIPTION


No. E (ft) (kg)
X
MISC 1 F 124 11 1.BA IN ASE 2. BA IN FTW
AE

MISC 1 M 119 10.4 PCAP-C, BAIAME FTW

MISC 14 F 16 44.3 SEPSIS; R/O DAT + 1 BANANA


APPENDICITIS
MISC 14 M PCAP-C FTW

MISC 3MOS M 58 5.8 PCAP-C FTW

MISC 1 Y.O F 11.3 PCAP-D FTW

SARI 5 M 113 17 ACUTE DAT


PYELONEPHRITIS,
PCAP A/B
SARI 2 F 86 10.5 T/C ASPIRATION FTW
PNEUMONIA
SARI 15 M 150 36.9 DENGUE FEVER DAT+ NO CHOCO COLORED FOOD

SARI 4 F DENGUE FEVER DAT+ NO CHOCO COLORED FOOD

SARI 7 M BRONCHIAL ASTHMA HYPOALLERGENIC DIET

SARI 6MOS F 65 HYPOVOLEMIC SHOCK FTW

ILI NB F 51 2.8 LIVE TERM FEMALE FTW


NEONATE
ILI 3DAYS M 50 3 SEPSIS NEONATORUM FTW

ILI NB M 50 3.1 FULL TERM FTW

ILI NB M 47 2.5 TERM FTW

ILI NB F 47 2.5 TERM FTW

ILI
SARI
SARI
SARI
SARI
SARI
SARI
SARI
SARI
POSITI
VE
ISO

DAFFODIL S. GONZAGA, RND HYACINTH R. DELA CERNA, RN

NUTRITIONIST DIETTITIAN

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