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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
Last Revised 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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The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.

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