THE PRESBYTERIAN HOSPITAL
DIET SHEET
| _______________ Division | ||||||||||||
| New York _________ 190___ | ||||||||||||
| Ward No. ____________ |
||||||||||||
| NAMES OF PATIENTS |
||||||||||||
| House diet | ||||||||||||
| Convalescent diet | ||||||||||||
| Nitrogenous diet | ||||||||||||
| Farinaceous diet | ||||||||||||
| Milk diet | ||||||||||||
| Extra diet | ||||||||||||
| No. of patients on house diet ______________ | ||||||||||||
| No. of patients on convalescent diet ________ | ||||||||||||
| No. of patients on nitrogenous diet _________ | ||||||||||||
| No. of patients on farinaceous diet _________ | ||||||||||||
| No. of patients on milk diet _______________ | ||||||||||||
| No. of patients on extra diet _______________ | ||||||||||||
| Total No. of patients in ward __________ | ||||||||||||
| ___________________________ | ||||||||||||
| Attending Physician—Surgeon | ||||||||||||
| _______________________ | ||||||||||||
| House Physician—Surgeon | ||||||||||||
| SAMPLE DIET SHEET |
||||||||||||