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Sodium Record

Sodium Record

Use this form to record the sodium content of the foods you eat or drink each day. This record will help you see whether you are getting the prescribed daily amount of sodium in your diet.

Take this record with you when you visit your health professional.

My doctor recommends that I have ___________milligrams (or ______ grams) of sodium in my diet each day.

Meal

Foods and beverages consumed during the meal

Total milligrams (or grams) of sodium in each meal

Breakfast

 

   
Snack

 

   
Lunch

 

   
Snack

 

   
Dinner

 

   
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Rhonda O'Brien, MS, RD, CDE - Certified Diabetes Educator
Current as of July 12, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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