Outline Of Chart

(Left Half)

No.

Name

Present Address

Permanent Address

Date

Vol.

Sp. Gr.

Reac.

Alb.

Acetone

Diacetic Acid

B-oxy bu'ric Acid

Nitrogen

Ammonia

Fehl-ing's

Fer'ta-tion

Rotation

Total

% of Nitrogen

Before

After

Fermentation

(Right Half)

Laevu-lose

Pentose

Urine Total Sugar

DIET

NaHCO3

Carbohydrate Balance

Weight of Patient

REMARKS

Total Carb.

Protein

Fat

Calories

Opposite side of Chart

Date

Orders

Breakfast

Forenoon

Dinner

Afternoon

Supper

Night

Strict Diet

Meat, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee and tea, and for variety, tongue, sweetbreads, tripe, kidneys, pig's feet, brains, bone marrow, anchovies, caviar, lobster, crabs, sardines, shrimps, bologna sausage, smoked or pickled meat, or fish.

Per Cent, of Carbohydrates in 5% or Less.

Lettuce.

Spinach.

Sauerkraut.

String Beans.

Celery.

Asparagus.

Cucumbers.

Brussels Sprouts.

Sorrel.

Endive.

Cauliflower.

Tomatoes.

Rhubarb.

Egg Plant.

Leeks.

Beet Greens.

Watercress.

Butternuts.

Unsweetened and Unspiced Pickle.

Ripe Olives Grape Fruit.

Clams Scallops Fish Roe.

6% or Less.

Cabbage Radishes Pumpkin Kohl-rabi.

Oysters Liver.

10% + Onions Squash Turnip Carrots Okra Beets Mushrooms.

Lemons.

Oranges.

Cranberries.

Strawberries.

Blackberries.

Gooseberries.

Peaches.

Pineapple.

Watermelon.

Musk Melon.

Brazil Nuts.

15% + Green Peas Artichokes Parsnips.

Canned Lima Beans Apples Pears Apricots Cherries Currants Raspberries Huckleberries.

Pecans.

Filberts.

Walnuts.

Pistachios.

Beechnuts.

20% + Potatoes.

Shell Beans Baked Beans Green Corn Boiled Rice Boiled Macaroni.

Plums Bananas.

Almonds.