Medical Nutrition Therapy

Transcription

1 501 New Karner Road. Suite 1A Albany, NY (518) Option 1 Clare DiSanto, RD, CDN, CDE Registered Dietitian/Certified Dietitian Educator Laurie Burton-Grego, MS, RD, CDN, CDE Registered Dietitian/Certified Dietitian Educator Lisbeth Irish, RDN, CDN, CDE Registered Dietitian/Certified Dietitian Educator Medical Nutrition Therapy Congratulations! You ve made the decision to begin your journey toward better health. CapitalCare is here to support you in this endeavor by providing Medical Nutrition Services. You have been scheduled for your first appointment with: Clare DiSanto, RD, CDN, CDE Laurie Burton-Grego, MS, RD, CDN, CDE Lisbeth Irish, RDN, CDN, CDE on at am/pm for a(n) individual appointment at. (site) One way we can assist you is to provide general information regarding insurance coverage for these services. However, CapitalCare participates with many insurance companies and there are multiple plans and benefit packages available to our patients. Therefore, it is very important for you to understand your individual policy and its benefits. We suggest the following: Please call your insurance company and ask if you have coverage for medical nutrition therapy with a dietitian. Make sure you ask whether you have to make a co-payment for this service, if you need referrals and whether any restrictions apply. For example, many insurance companies only provide coverage for certain conditions, or for a limited number of visits. Most insurance company ID cards have a toll-free number to call regarding benefits; it may be on the front of the back of the card Be sure your primary care physician has arranged a referral prior to your appointment. We will ask you to sign an insurance waiver at the time of your visit. If it is determined that medical nutrition therapy is not a covered benefit with your health plan, you will be responsible for the medical nutrition therapy fees. Additional information is available upon request. Please fill out the attached from and bring it with you to your appointment. If you have further questions, please call (518) , option 1.

2 Sizing Your Servings When measuring cups or a food scale are not handy, use these tricks to help you estimate your portions! 1. 3 oz. of meat is about the size and thickness of a deck of playing cards 2. A medium apple or orange is about the size of a tennis ball 3. 1 ounce of nuts or small candies equals one handful 4. 1 oz. of cheese is about the size of 4 stacked dice 5. 1 cup of ice cream is about the size of a baseball 6. 1 cup of broccoli is about the size of a light bulb 7. 1 teaspoon of butter is about the size of the tip of your thumb

3 Kids Quick Nutrition Assessment MR # Please fill out this brief nutrition assessment form to make our counseling time more effective. Thank you! Name Age Reason for visit Appt. Date Referred by Doctor 1. Have you ever had nutrition counseling before? Yes No 2. If yes, please describe 3. What school do you go to? 4. What grade are you in? 5. Are you on any sports teams or in any after-school clubs? 6. What are some of your hobbies? 7. How tall are you? 8. How much do you weigh? 9. What are your favorite foods? 10. What foods do you dislike? 11. Do you buy lunch/snacks at school? 12. Do you bring your lunch/snacks to school? 13. What restaurants do you frequently go to? 14. How many times per week do you go out to eat? 15. Do you have any food allergies? If yes, please list: 16. Do you take any vitamins, minerals, or herbals? If so, please list. 17. Please list the medications and dose you are currently taking. 18. Any comments or topics you specifically would like to talk about with the dietitian? Dietitian s Initials Appt. Date

4 Please bring to your appointment completed MR # 3-day food record Please list everything you eat or drink for 3 days. If possible, two weekdays and one weekend day. Eat what ever is normal for you. Pick a time to start recording and then end at that same time the next day. Record the time, place, amount (measure with measuring cups or use the Sizing your Servings handout that is attached) and preparation of each food or beverage item below right after it has been consumed. This is easiest if you carry this record around with you and record what you eat right when you re done rather then waiting until the end of the day to try to remember everything you have consumed. If you have any questions please call option 1. Day 1 Time and where consumed Example: 7:30am at the kitchen table 5:30 pm at home on back deck Begin your day here: Type of food or beverage Raisin bran Milk OJ Hamburger Bun Tomato Ketchup Homemade fries Amount consumed* 1 cup ½ cup 6 oz 3 oz (size of a deck of cards) 1 whole bun 2 tomato slices 1 tbsp of ketchup 6 thin sliced fries Method of preparation (include all ingredients) No preparation required Barbequed meat with added freshly chopped onions Baked fries, sprinkled with pepper and salt *Use label information, measuring cups, food scale and/or Sizing your Servings handout.

5 Day 2 MR# Time and where consumed Type of food or beverage Amount consumed* Method of preparation (include all ingredients) *Use label information, measuring cups, food scale and/or Sizing your Servings handout.

6 Day 3 MR # Time and where consumed Type of food or beverage Amount consumed* Method of preparation (include all ingredients) *Use label information, measuring cups, food scale and/or Sizing your Servings handout.