TK III DR BRATANATA
Berat Badan : .........................kg Tinggi Badan : ........................cm Makan Pagi Makan Siang Makan Malam
Indeks Massa Tubuh (IMT) : ......................................................kg/m Nasi/Nasi Tim/Bubur Nasi/Nasi Tim/Bubur Nasi/Nasi Tim/Bubur
Status Gizi : ................................................................... Telur dadar isi wortel Rolade Daging Tumis Ayam Suwir
Energi : ...............................kkal Lemak : ........................................ gram Tahu Bacem Perkedel Kentang Perkedel Tahu
MAKANAN SEHAT
Protein: ..............................gram Karbohidrat : ........................................ gram Cah Bayam Sup Sayuran Kacang Capcai sayuran
Pisang Ambon Merah Jeruk
Pepaya
LANJUT USIA
PEMBAGIAN MAKAN SEHARI
Makan Pagi jam 06.00 - 08.00 Selingan Selingan Selingan
Nama Makanan Berat (gram) URT* Kue Nagasari Jus Alpukat Biskuit
..................... ..................... .....................
Lauk Hewani : ..................... ..................... ..................... CAIRAN DARI MAKANAN DAN MINUMAN
..................... ..................... ..................... ±6 GELAS PER HARI
Sayuran : ..................... ..................... .....................
Buah : ..................... ..................... .....................
Minyak** : ..................... ..................... .....................
Selingan pagi jam 10.00 :
CATATAN KONSELOR
...........................................................................................................
Makan Siang jam 12.00 - 13.00
Nama Makanan Berat (gram) URT*
..................... ..................... .....................
Gambar Lansia Berolahraga
Lauk Hewani : ..................... ..................... .....................
..................... ..................... .....................
Sayuran : ..................... ..................... .....................
Buah : ..................... ..................... .....................
Minyak** : ..................... ..................... .....................