Weekly Food Intake Log

A 4-page log of one week of meals, how much was eaten, and fluids, written for the care team.

For a USA non-medical home care agency. You get one editable Word file. It records what was offered and eaten. It is not a nutrition assessment.

What's included

1. Page 1: a Sunday-to-Saturday grid for breakfast, lunch, dinner, and snacks, with time, what was offered, and amount eaten
2. Page 2: daily fluid totals, whether the fluid goal was met, and an optional morning, midday, and evening fluid check with hydration notes
3. Page 3: diet reminders from the care plan, assistance at meals, refusals, and chewing or swallowing observations to report, not to diagnose
4. Page 4: a weekly summary, escalation and notifications, care-team questions, and signature lines

Add your logo and name

1. Open the Word file and insert your logo in the Agency Logo box on the log.
2. Replace Agency Name with your agency name.
3. Replace the phone and on-call lines with yours.
4. Save. Caregivers fill in the Word file during the week.

Editable template for your agency to adapt. Not legal advice, not medical advice, not a license to operate, and not HIPAA software. Match the log to your state rules and your care-plan policy before you use it.