Use
this form to record the
sodium content of the foods you eat or drink each day.
This record will help you see whether you are getting the prescribed daily
amount of sodium in your diet.
Take this record with you when you
visit your health professional.
My doctor recommends that I have
___________milligrams (or ______ grams) of sodium in my diet each day.
|
Meal
|
Foods and beverages consumed during the meal
|
Total milligrams (or grams) of sodium in each meal
|
| Breakfast |
|
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| Snack |
|
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| Lunch |
|
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| Snack |
|
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| Dinner |
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By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Kathleen Romito, MD - Family Medicine |
|
Specialist Medical Reviewer
|
Rhonda O'Brien, MS, RD, CDE - Certified Diabetes Educator |
|
Last Revised
|
July 12, 2012 |