Project: Senior Nutrition Services

Appendix 1 Provider Name: Proposed Use Dates:

MENUS APPROVED BY: Week: PROJECT NUTRITIONIST DATE

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Saturday Sunday Meat or Alternate ( 3 oz. Cooked Edible Portion )

List Portion Size & Food Components Of All Extended Entrees. (e.g., Casseroles )

Vegetables (1 –2 - half cup Servings )

Fruit (1/2 cup serving) Vit. A (*) Vit. C (+) Daily Bread or Alternate ( 1-2 Servings ) Half should be whole grain Fortified Margarine ( Optional ) Dessert - Optional ( ½ Cup Serving )

Key Nutrients Mg. Mg. Mg. Mg. Vit. Mg. Mg. Mg. Vit. Vit. C Vit. C Vit. C C Vit. C Vit. C C Mg. Mg. Mg. Mg. Mg. Mg. Mg. Sodium Sodium Sodium Sodium Sodium Sodium Sodium Fortified Milk ( 8 Oz. Serving ) Fat-Free, Low-Fat, Buttermilk, or alternate NOTES: Use fruit as Dessert as often as possible, limit concentrated sweets – fruit and grains served in dessert can count towards the fruit and/or grain requirement Rich vitamin A source (*) 3 times a week for 5-day menu, 4 times a week for 7-day menu at 233+ ug. Rich vitamin C source (+) daily at 25+ mg. “Key Nutrient” section: UNLESS from a single source, list the total amount of vitamin C provided in menu. If meal provides 1,000+ mg sodium, indicate “HIGH”

0cdcc127563798bfa64c8b63b4365d3b.doc December 2016