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Your Name: Date meal is to be delivered:
Your Email Address: Time meal is to be delivered:
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    Patient's Room Number:

Breakfast
Breakfast Entrees Sides
Scrambled Eggs Pork Sausage
Scrambled Eggs Substitute * Bacon Slice
Texas French Toast (2) * Turkey Sausage Patty
Buttermilk Pancakes (2) * Grilled Turkey *
  Hash Browns (1.5)
   
Omelet Shoppe (Made-to-Order) Fruit *
Regular Eggs Egg Substitute * Apple (1) Applesauce (1)
  Quartered Orange (1.5) Peach Slices (1)
Omelet Extras
Banana (1)
Pear Halves (1)
Cheddar Swiss * Seasonal Fruit Cup (1) Pineapple Chunks (1)
Provolone * Tomato *  
Green Pepper * Spinach * Bake Shop
Fresh Mushrooms * Diced Ham Plain Bagel (2) *
Bacon Sausage Cinnamon Raisin Bagel (2) *
Grilled Turkey *   English Muffin (1.5) *
  Buttermilk Biscuit (1.5)
Cereals * Fresh Baked Cinnamon Roll
Cream of Wheat® (1.5)  
Oatmeal (2) Muffins
Rice Krispies® (1.5) Plain (1) Blueberry (1)
Cornflakes® (1)  
Frosted Flakes® (2) Low-Fat Yogurt (1) *
Cheerios® (1) Vanilla Blueberry
Raisin Bran® (2) Strawberry  
Bran Flakes® (1.5)  
Shredded Wheat® (2)  
 
Liquid Diets
Clear Liquid Diet Full Liquid Diet
Broths * Includes all clear liquid diet items plus the following:
Chicken Vegetable Tomato Soup (1)
Beef   Cream of Chicken Soup (1)
    Cream of Wheat® (1.5) *
Juice *  
Cranberry (1.5) Peach (1) Juice *
Apple (1) Lemonade (1) Orange (1) Prune (1.5)
   
Soda Milk
Lemon-Lime Skim (1) * 2% (1)
Cola Regular Diet Whole (1) Chocolate (2)
Caffeine-Free Diet Cola * Lactose-Free (1) *  
Vernors® Regular Diet  
  Hot Chocolate (1)
Coffee Regular Decaf * Sugar-Free Hot Chocolate (0.5)
Hot Tea Regular Decaf *  
Iced Tea Pudding
  Vanilla (2) Sugar-Free Vanilla (1)
Finishing Touches * Chocolate Pudding (1.5)
Popsicle: Assorted (1) Regular Sugar-Free  
Fruit Ice: Assorted (1) Ice Cream
Jell-O®: Assorted (1) (Sugar-Free) Vanilla (1) Chocolate (1.5)
 
Lunch/Dinner
Deli Bar
Create your own sandwich
Meats & Fillings Cheeses Garden Sides
Roast Beef American Lettuce * Baked Potato Chips (1.5) *
Roast Turkey * Swiss * Tomato * Potato Chips (1)
Ham Provolone * Pickle Pretzels (1.5) *
Tuna Salad *   Onion *  
Chicken Salad *   Cucumber *  
       
Bread Basket Condiments
White (1) * Salt Pepper Mrs. Dash®
Wheat (1) * Margarine Sour Cream Parmesan Cheese
Rye (1) * Peanut Butter Jelly Regular Diet Brown Sugar (2)
Dinner Roll (1) * Sugar Non-Dairy Creamer Lemon Juice (1)
Biscuit (1.5) Honey Ketchup Mustard
Corn Muffin (1.5) Relish Pancake Syrup Regular Sugar-Free
Crackers (1)
Regular Low Sodium *
Salsa Cream Cheese Regular Low-Fat
  BBQ Sauce Mayonnaise Regular Light
  Tartar Sauce  
 
Beverages Desserts
Milk Cakes *
Skim (1) * 2% (1) Angel Food (2) Apple Crisp (3)
Whole (1) Chocolate (2) Rice Krispies Treat® (2)
Lactose Free (1) *  
  Cookies
Cold Drinks Vanilla Wafers (1) * Graham Crackers (1) *
Lemonade (Sugar-Free) Iced Tea Sugar (1.5) Chocolate Chip (1.5)
  Oatmeal Raisin (1.5) Peanut Butter (1.5)
Juice *  
Apple (1) Prune (1) Pudding *
Peach (1) Orange (1.5) Vanilla (2) Sugar-Free Vanilla (1)
Cranberry (1.5)   Chocolate Pudding (1.5)
   
Soda Ice Cream
Lemon-Lime Vanilla (1) Chocolate (1.5)
Cola Regular Diet Popsicle: Assorted (1) * Regular Sugar-Free
Caffeine-Free Diet Cola * Orange Sherbet (2) *
Gingerale Regular Diet Fruit Ice: Assorted (1) *
  Jell-O®: Assorted (1) (Sugar-Free) *
Hot Drinks  
Coffee Regular Decaf * Low-Fat Yogurt (1) *
Hot Tea Regular Decaf * Vanilla
Hot Chocolate (1.5) Blueberry
Sugar-Free Hot Chocolate (0.5) Strawberry
   
  Low-Fat Yogurt Parfait (1) *
  Vanilla
  Strawberry
 
Lunch/Dinner
Grill Favorites
Hamburger (2) Grilled Cheese (2)
Cheeseburger (2) Fish Sandwich (3.5)
Grilled Chicken * Chicken Fingers (2)
Grilled Ham & Cheese (2) Lettuce * Tomato *
  Onion *  
American Comforts  
Lemon Sage Chicken Breast * Asian Stir-Fry *
Sliced Roast Turkey Breast * Vegetable (1.5) Chicken (1)
Crispy Baked Fish (0.5) * Tofu (1.5) White Rice (1.5)
Macaroni and Cheese (3)  
Chicken and Biscuits South of the Border
Farmer's Meatloaf (0.5) Quesadilla
  Cheese (4) Chicken (4)
Accompaniments Roasted Vegetable (4)
On the Side  
Whipped Potatoes (1.5) * Sweet Potato (2) * Tacos (1 taco)
Steak Fries (1.5) Noodles (2) * Chicken (1) *
Steamed White Rice (1.5) *      
  Chicken Taco Salad *
Vegetables *  
Sliced Carrots Green Beans Broths & Soups
Broccoli Corn (1) Broth *
Summer Squash & Carrots Medley   Chicken Beef
  Vegetable  
   
Salads Soups
Garden Salad * Chef Salad (1) Chicken Noodle (1) * Tomato (1)
Grilled Chicken Salad (0.5) * Carrot & Celery Sticks * Cream of Chicken (1) Vegetable (1) *
Cottage Cheese & Fruit Plate (2) * Seasonal Fruit Plate (2) *  
Creamy Cole Slaw (0.5)    
   
Salad Dressings  
Italian Regular Fat-Free * Balsamic Vinaigrette  
French Regular Fat-Free * Honey Mustard  
Ranch Regular Fat-Free *  

Comments or Special Instructions:

 

 

If your doctor has prescribed a modified diet, some items may not be available.
*= Choices for sodium / cholesterol restricted diets
(#) = Carbohydrate exchanges / 15 gm per exchange