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Diet Requisition Sheet

(TO BE SUBMITTED BY 13:30 PM ON THE DAY PRIOR TO REQUIREMENT)

Date: Ward:

DIET SPECIFICATION PATIENT


BED HOSP SPECIAL EXPECTATION
PATIENT NAME ATTENDANT
NO. NO. BF L D INSTRUCTIONS FOR THE NEXT
DAY

N Normal Diet DM Diabetic Diet IDDM Diabetic on Insulin


R Renal BL Bland LS Low Salt
S Soft FL Fluid NG Nasogastric
NPM Nil By Mouth LF Low Fat LP Low Protein
BF Breakfast L Lunch D Dinner

Contact Numbers: 2277- 4865, 2277- 4867

**Note: Kindly note that, clearing patients’ meals after one hour from serving time.

COP-CL-002- Diet Requisition Sheet

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