6 month diet question
on 9/15/07 1:12 pm - Oakland, TN
Sorry I don't know if I sent it to you. I normally don't check this board, if you sent me a PM or email I hope you received the document.
I posted it in another post or if you send me your email address I would be happy to send it to you. Best of luck, Jen [email protected]
PHYSICIAN SUPERVISED WEIGHT-LOSS PROGRESS NOTE
Diet, Exercise and Behavior Modification
Patient Name: ________________________________________
Date of Birth: _________________________________________
Date of Visit: _________________________________________
S:
Patient is following a
q 800 kcal/day diet
|
q 1500 kcal/day diet
|
q 1800 kcal/day diet
|
q 1200 kcal/day diet
|
q 1600 kcal/day diet
|
q 2000 kcal/day diet
|
q 1400 kcal/day diet
|
q 1700 kcal/day diet
|
q Other
|
Patient is participating in the following exercise regimen, as discussed:
q Walking
|
q Yoga
|
q Swimming
|
q Aerobics
|
q Curves
|
q Gym/Club membership
|
q Patient unable to exercise due to __________________________________________________
q Other ________________________________________________________________________
O:
Vitals
Height: _____ Weight: _____ HR: _____ R: _____ BP: _____
A:
q Morbid Obesity
q Change in weight since last visit
Lost _____ lbs.
Gained _____ lbs.
q No change in weight since last visit
P:
Patient is to follow a
q 800 kcal/day diet
|
q 1500 kcal/day diet
|
q 1800 kcal/day diet
|
q 1200 kcal/day diet
|
q 1600 kcal/day diet
|
q 2000 kcal/day diet
|
q 1400 kcal/day diet
|
q 1700 kcal/day diet
|
q Other
|
q Patient is to continue exercise
q Return to office in one month to evaluate progress
q Patient counseled on the importance of behavior modification and lifestyle changes
Additional Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________
Physician Signature