Lampiran 1.

Recall Pasien 1

Protein Vit. Vit.

Waktu Menu Bahan Makanan Berat Energi LEMAK H A Ca Fosfor Fe Vit. A Natrium Kalium Coles Serat AIR
B1 C
Hewani Nabati
Pagi
Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5

Empal daging Daging sapi 50 103.5 9 0 7 0 5.5 85 1.4 15 0.04 0 46.5 244.5 35 0 33

Telur asin rebus Telur bebek 30 56.7 3.93 0 4.29 0.24 16.8 52.5 0.84 369 0.054 0 57.3 77.4 0 0 21.24
Tempe kedele
Mendol murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16
Brongkos labu siam
kacang panjang Labu siam 30 7.8 0 0.18 0.03 2.01 4.2 7.5 0.15 6 0.006 5.4 0 0 0 0.9 27.69

Kacang panjang 25 11 0 0.675 0.075 1.95 12.25 86.75 0.175 83.75 0.0325 5.25 1.3 13.855 0 1.7 22.125

Snack Kentang rebus Kentang 30 24.9 0 0.6 0.03 5.73 3.3 16.8 0.21 0 0.033 5.1 2.1 118.8 0 0.75 23.34
Siang
Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5

Ayam bumbu rujak Ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925

Orem-orem tahu Tahu 25 17 0 1.95 1.15 0.4 31 15.75 0.2 0 0.015 0 3 37.75 0 0.125 21.2
Urap-urap sayuran
Kacang panjang 30 13.2 0 0.81 0.09 2.34 14.7 104.1 0.21 100.5 0.039 6.3 1.56 16.626 0 2.04 26.55
Tauge kacang
kedele 10 6.7 0 0.9 0.26 0.64 5 6.5 0.1 11 0.023 1.5 0 0 0 0.59 8.1
malam
Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Telur bumbu semur
Telur ayam 30 48.6 3.84 0 3.45 0.21 16.2 54 0.81 270 0.03 0 47.4 53.4 165 0 22.2

Kecap 2.5 1.15 0 0.1425 0.0325 0.225 3.075 2.4 0.1425 0 0 0 100 12.5 0 0 1.575
Tempe kedele
Tempe mendoan murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16
Sambel goreng
labu siam tempe Labu siam 25 6.5 0 0.15 0.025 1.675 3.5 6.25 0.125 5 0.005 4.5 0 0 0 0.75 23.075
Tempe kedele
murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16
Total
1265.3 61.4525 39.4075 163.02 233.275 948.05 14.3875 1505.25 0.675 28.05 342.91 1012.331 245 15.605 342.77
Lampiran 2. Recall Pasien 2

Wakt Bahan Bera Protein LEMA Fosfo Vit. Vit. Natriu Cole
Menu Energi Hewa Naba H A Ca Fe Vit. A Kalium Serat AIR
u Makanan t K r B1 C m s
ni ti
Pagi 59.17
Nasi Beras giling 75 270 0 5.1 0.525 5 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Empal daging Daging sapi 50 103.5 9 0 7 0 5.5 85 1.4 15 0.04 0 46.5 244.5 35 0 33

Telur asin rebus Telur bebek 50 94.5 6.55 0 7.15 0.4 28 87.5 1.4 615 0.09 0 95.5 129 0 0 35.4
Tempe kedele 32.2 0.042
Mendol murni 25 37.25 0 4.575 1 3.175 5 38.5 2.5 12.5 5 0 0 0 0 1.75 16
Brongkos labu siam
kacang panjang Labu siam 30 7.8 0 0.18 0.032.01 4.2 7.5 0.15 6 0.006 5.4 0 0 0 0.9 27.69
Kacang 17.1 121.4 0.24 0.045
panjang 35 15.4 0 0.945 0.105 2.73 5 5 5 117.25 5 7.35 1.82 19.397 0 2.38 30.975
Snac
k Kentang rebus Kentang 30 24.9 0 0.6 0.03 5.73 3.3 16.8 0.21 0 0.033 5.1 2.1 118.8 0 0.75 23.34
Siang 59.17
Nasi Beras giling 75 270 0 5.1 0.525 5 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Ayam bumbu rujak Ayam 50 151 9.1 0 12.5 0 7 100 0.75 405 0.04 0 50 175 30 0 27.95

Orem-orem tahu Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4
Urap-urap sayuran Kacang
panjang 30 13.2 0 0.81 0.09 2.34 14.7 104.1 0.21 100.5 0.039 6.3 1.56 16.626 0 2.04 26.55
Tauge kacang 0.034
kedele 15 10.05 0 1.35 0.39 0.96 7.5 9.75 0.15 16.5 5 2.25 0 0 0 0.885 12.15
mala
m Nasi Beras giling 100 360 0 6.8 0.7 78.9 6 140 0.8 0 0.12 0 5 100 0 2 13
Telur bumbu semur
Telur ayam 60 97.2 7.68 0 6.9 0.42 32.4 108 1.62 540 0.06 0 94.8 106.8 330 0 44.4
0.28
Kecap 5 2.3 0 0.285 0.065 0.45 6.15 4.8 5 0 0 0 200 25 0 0 3.15
Tempe kedele 32.2 0.042
Tempe mendoan murni 25 37.25 0 4.575 1 3.175 5 38.5 2.5 12.5 5 0 0 0 0 1.75 16
Sambel goreng labu
siam tempe Labu siam 10 2.6 0 0.06 0.01 0.67 1.4 2.5 0.05 2 0.002 1.8 0 0 0 0.3 9.23
Tempe kedele
murni 10 14.9 0 1.83 0.4 1.27 12.9 15.4 1 5 0.017 0 0 0 0 0.7 6.4
 1545.8 221.3 281. 1121. 14.8 1847.2 1160.62 16.70 387.13
Total
5 68.44 40.72 8 7 3 7 5 0.822 28.2 510.78 3 395 5 5
Lampiran 3. Recall Pasien 3

Bahan Protein Vit. Vit.

Waktu Menu Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Natrium Kalium Coles Serat AIR
Makanan B1 C
Hewani Nabati
Pagi
Nasi Beras giling 25 90 0 1.7 0.175 19.725 1.5 35 0.2 0 0.03 0 1.25 25 0 0.5 3.25
Ayam
bumbu
bali Ayam 50 151 9.1 0 12.5 0 7 100 0.75 405 0.04 0 50 175 30 0 27.95
Semur
tahu Tahu 25 17 0 1.95 1.15 0.4 31 15.75 0.2 0 0.015 0 3 37.75 0 0.125 21.2

Kecap 2.5 1.15 0 0.1425 0.0325 0.225 3.075 2.4 0.1425 0 0 0 100 12.5 0 0 1.575
Cah wortel
sawi putih Wortel 20 8.4 0 0.24 0.06 1.86 7.8 7.4 0.16 2400 0.012 1.2 14 49 0 1 17.64

Sawi 15 3.3 0 0.345 0.045 0.6 33 5.7 0.435 969 0.0135 15.3 1.761 55.11 0 0.5865 13.83
Kentang
Snack rebus Kentang 20 16.6 0 0.4 0.02 3.82 2.2 11.2 0.14 0 0.022 3.4 1.4 79.2 0 0.5 15.56
Siang
Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5
Daging
bumbu Daging
rending sapi 25 51.75 4.5 0 3.5 0 2.75 42.5 0.7 7.5 0.02 0 23.25 122.25 17.5 0 16.5
Tempe Tempe
bumbu kedele
kare murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16
Bobor
sawi tauge Sawi 30 6.6 0 0.69 0.09 1.2 66 11.4 0.87 1938 0.027 30.6 3.522 110.22 0 1.173 27.66
Tauge
kacang
kedele 15 10.05 0 1.35 0.39 0.96 7.5 9.75 0.15 16.5 0.0345 2.25 0 0 0 0.885 12.15
malam
Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5
Telur
ceplok Telur ayam 30 48.6 3.84 0 3.45 0.21 16.2 54 0.81 270 0.03 0 47.4 53.4 165 0 22.2
Otak-otak
tahu Tahu 25 17 0 1.95 1.15 0.4 31 15.75 0.2 0 0.015 0 3 37.75 0 0.125 21.2

Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28
Sup wortel Jagung
jagung kuning pipil
manis baru 10 30.7 0 0.79 0.34 6.36 0.9 14.8 0.21 44 0.033 0 0 0 0 0 2.4
Total
866.2 38.8525 24.7225 121.555 263.775 518.95 8.5875 10862.5 0.4785 55.15 281.583 955.18 212.5 10.6445 267.395
Lampiran 4. Monitoring dan Evaluasi Pasien 1 (26 Februari 2019)

Bahan Protein Vit. Vit.

Waktu Menu Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Natrium Kalium Coles Serat AIR
Makanan B1 C
Hewani Nabati
Beras
Pagi Nasi giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Ayam
bumbu
bali Ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925
Semur
tahu Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4

Kecap 5 2.3 0 0.285 0.065 0.45 6.15 4.8 0.285 0 0 0 200 25 0 0 3.15
Cah
wortel
sawi
putih Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28
0.031
Sawi 35 7.7 0 0.805 0.105 1.4 77 13.3 1.015 2261 5 35.7 4.109 128.59 0 1.3685 32.27
Kentan
Snack g rebus Kentang 30 24.9 0 0.6 0.03 5.73 3.3 16.8 0.21 0 0.033 5.1 2.1 118.8 0 0.75 23.34
Beras
Siang Nasi giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Daging
bumbu Daging
rendang sapi 50 103.5 9 0 7 0 5.5 85 1.4 15 0.04 0 46.5 244.5 35 0 33
Tempe Tempe
bumbu kedele
kare murni 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bobor
sawi
tauge Sawi 40 8.8 0 0.92 0.12 1.6 88 15.2 1.16 2584 0.036 40.8 4.696 146.96 0 1.564 36.88
Tauge
kacang 0.034
kedele 15 10.05 0 1.35 0.39 0.96 7.5 9.75 0.15 16.5 5 2.25 0 0 0 0.885 12.15
Beras
malam Nasi giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Telur Telur
ceplok ayam 60 97.2 7.68 0 6.9 0.42 32.4 108 1.62 540 0.06 0 94.8 106.8 330 0 44.4
Otak-
otak
tahu Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4
Sup
wortel
jagung
manis Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28
Jagung
kuning
pipil baru 20 61.4 0 1.58 0.68 12.72 1.8 29.6 0.42 88 0.066 0 0 0 0 0 4.8
1453.9 209.84 400.8 10.62 88.6 13.567 416.52
Total
5 59.93 40.455 5 5 840.05 5 15712 0.739 5 506.455 1605.15 410 5 5
Lampiran 5. Monitoring dan Evaluasi Pasien 1 (27 Februari 2019)

Bahan Protein Vit. Vit.

Waktu Menu Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Natrium Kalium Coles Serat AIR
Makanan B1 C
Hewani Nabati

Pagi Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Ayam rica-
rica Ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925

Tahu goreng Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4
Cah wortel
sawi putih Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28

Sawi 35 7.7 0 0.805 0.105 1.4 77 13.3 1.015 2261 0.0315 35.7 4.109 128.59 0 1.3685 32.27
Pisang
Snack Pisang ambon 100 99 0 1.2 0.2 25.8 8 28 0.5 146 0.08 3 18 434 0 3 72

Siang Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Ayam
bumbu
koloke Ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925
Sambel Tempe
goreng kedele
tempe murni 10 14.9 0 1.83 0.4 1.27 12.9 15.4 1 5 0.017 0 0 0 0 0.7 6.4

Sup sehat Wortel 25 10.5 0 0.3 0.075 2.325 9.75 9.25 0.2 3000 0.015 1.5 17.5 61.25 0 1.25 22.05

Buncis 25 8.75 0 0.6 0.05 1.925 16.25 11 0.275 157.5 0.02 4.75 8.8 19.425 0 2.375 22.225
Kol
kembang 25 6.25 0 0.6 0.05 1.225 5.5 18 0.275 22.5 0.0275 17.25 7.5 87.25 0 1.625 22.925

malam Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Telur bumbu
kare Telur ayam 60 97.2 7.68 0 6.9 0.42 32.4 108 1.62 540 0.06 0 94.8 106.8 330 0 44.4

Bistik tahu Tahu 25 17 0 1.95 1.15 0.4 31 15.75 0.2 0 0.015 0 3 37.75 0 0.125 21.2
Lodeh
kacang
panjang labu
siam Labu siam 35 9.1 0 0.21 0.035 2.345 4.9 8.75 0.175 7 0.007 6.3 0 0 0 1.05 32.305
 Kacang
panjang 40 17.6 0 1.08 0.12 3.12 19.6 138.8 0.28 134 0.052 8.4 2.08 22.168 0 2.72 35.4
Total
1601.8 63.235 50.58 222.275 329.4 1027.55 10.31 12288 0.769 79.3 351.039 1820.733 420 20.9635 501.955
Lampiran 6. Monitoring dan Evaluasi Pasien 1 (28 Februari 2019)

Protein
Waktu Menu Bahan Makanan Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Vit. B1 Vit. C Natrium Kalium Coles Serat AIR
Hewani Nabati

Pagi Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Kare ayam Ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925

Tempe bumbu bali Tempe kedele murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16

Cah tauge wortel Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28

Tauge kacang kedele 35 23.45 0 3.15 0.91 2.24 17.5 22.75 0.35 38.5 0.0805 5.25 0 0 0 2.065 28.35

Snack Pisang Pisang ambon 100 99 0 1.2 0.2 25.8 8 28 0.5 146 0.08 3 18 434 0 3 72

Siang Nasi Beras giling 100 360 0 6.8 0.7 78.9 6 140 0.8 0 0.12 0 5 100 0 2 13

Telur bumbu bali Telur ayam 60 97.2 7.68 0 6.9 0.42 32.4 108 1.62 540 0.06 0 94.8 106.8 330 0 44.4

Balado tempe Tempe kedele murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16

Bobor Bayam 40 14.4 0 1.4 0.2 2.6 106.8 26.8 1.56 2436 0.032 32 1.6 166.4 0 1.4 34.76

Labu siam 20 5.2 0 0.12 0.02 1.34 2.8 5 0.1 4 0.004 3.6 0 0 0 0.6 18.46

malam Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Balado tuna Ikan segar 50 56.5 8.5 0 2.25 0 10 100 0.5 75 0.025 0 50.25 150 0 0 38

Rempah tahu Tahu 25 17 0 1.95 1.15 0.4 31 15.75 0.2 0 0.015 0 3 37.75 0 0.125 21.2

Sup Wortel 25 10.5 0 0.3 0.075 2.325 9.75 9.25 0.2 3000 0.015 1.5 17.5 61.25 0 1.25 22.05

Kentang 25 20.75 0 0.5 0.025 4.775 2.75 14 0.175 0 0.0275 4.25 1.75 99 0 0.625 19.45

Kapri muda 25 10.5 0 0.825 0.05 2.25 12.75 21.25 0.25 110 0.05 4.75 0.25 92.5 0 0 21.7

Total
1572.3 65.905 34.4 249.47 339.35 942.6 13.9 11782 0.858 56.75 302.65 1758.2 375 19.565 462.075
Lampiran 7. Monitoring dan Evaluasi Pasien 2 (26 Februari 2019)

Bahan Protein Vit.

Waktu Menu Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Vit. B1 Natrium Kalium Coles Serat AIR
Makanan C
Hewani Nabati
Beras
Pagi Nasi giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Ayam
bumbu
bali Ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925
Semur
tahu Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4

Kecap 5 2.3 0 0.285 0.065 0.45 6.15 4.8 0.285 0 0 0 200 25 0 0 3.15
Cah
wortel
sawi
putih Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28

Sawi 35 7.7 0 0.805 0.105 1.4 77 13.3 1.015 2261 0.0315 35.7 4.109 128.59 0 1.3685 32.27
Kentang
Snack rebus Kentang 60 49.8 0 1.2 0.06 11.46 6.6 33.6 0.42 0 0.066 10.2 4.2 237.6 0 1.5 46.68
Beras
Siang Nasi giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Daging
bumbu Daging
rendang sapi 50 103.5 9 0 7 0 5.5 85 1.4 15 0.04 0 46.5 244.5 35 0 33
Tempe Tempe
bumbu kedele
kare murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16
Beras
malam Nasi giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Telur Telur
ceplok ayam 60 97.2 7.68 0 6.9 0.42 32.4 108 1.62 540 0.06 0 94.8 106.8 330 0 44.4
Otak-
otak
tahu Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4
Sup
wortel
jagung
manis Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28
 Jagung
kuning
pipil baru 25 76.75 0 1.975 0.85 15.9 2.25 37 0.525 110 0.0825 0 0 0 0 0 6
Total
1512.6 63.23 41.145 219.37 341.35 877.8 12.13 13146 0.7605 50.7 503.859 1576.99 410 13.6185 408.035
Lampiran 8. Monitoring dan Evaluasi Pasien 2 (27 Februari 2019)

Protein Vit. Vit.

Waktu Menu Bahan Makanan Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Natrium Kalium Coles Serat AIR
B1 C
Hewani Nabati

Pagi Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Ayam rica-rica 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925

Tahu goreng Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4

Cah wortel sawi putih Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28

Sawi 35 7.7 0 0.805 0.105 1.4 77 13.3 1.015 2261 0.0315 35.7 4.109 128.59 0 1.3685 32.27

Snack Pisang Pisang ambon 75 74.25 0 0.9 0.15 19.35 6 21 0.375 109.5 0.06 2.25 13.5 325.5 0 2.25 54

Siang Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5

Ayam bumbu koloke Ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925
Tempe kedele
Sambel goreng tempe murni 10 14.9 0 1.83 0.4 1.27 12.9 15.4 1 5 0.017 0 0 0 0 0.7 6.4

Sup sehat Wortel 25 10.5 0 0.3 0.075 2.325 9.75 9.25 0.2 3000 0.015 1.5 17.5 61.25 0 1.25 22.05

Buncis 25 8.75 0 0.6 0.05 1.925 16.25 11 0.275 157.5 0.02 4.75 8.8 19.425 0 2.375 22.225

Kol kembang 25 6.25 0 0.6 0.05 1.225 5.5 18 0.275 22.5 0.0275 17.25 7.5 87.25 0 1.625 22.925

malam Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Telur bumbu kare Telur ayam 60 97.2 7.68 0 6.9 0.42 32.4 108 1.62 540 0.06 0 94.8 106.8 330 0 44.4

Bistik tahu Tahu 10 6.8 0 0.78 0.46 0.16 12.4 6.3 0.08 0 0.006 0 1.2 15.1 0 0.05 8.48
Lodeh kacang panjang
labu siam Labu siam 20 5.2 0 0.12 0.02 1.34 2.8 5 0.1 4 0.004 3.6 0 0 0 0.6 18.46

Kacang panjang 40 17.6 0 1.08 0.12 3.12 19.6 138.8 0.28 134 0.052 8.4 2.08 22.168 0 2.72 35.4

Total
1472.95 59.975 49.65 194.855 305.2 972.35 9.79 12248.5 0.707 75.85 343.489 1664.583 420 19.1885 454.14
Lampiran 9. Monitoring dan Evaluasi Pasien 2 (28 Februari 2019)

Bahan Protein
Waktu Menu Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Vit. B1 Vit. C Natrium Kalium Coles Serat AIR
Makanan
Hewani Nabati

Pagi Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5
Kare
ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925
Tempe Tempe
bumbu kedele
bali murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16
Cah
tauge
wortel Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28
Tauge
kacang
kedele 10 6.7 0 0.9 0.26 0.64 5 6.5 0.1 11 0.023 1.5 0 0 0 0.59 8.1
Pisang
Snack Pisang ambon 100 99 0 1.2 0.2 25.8 8 28 0.5 146 0.08 3 18 434 0 3 72

Siang Nasi Beras giling 100 360 0 6.8 0.7 78.9 6 140 0.8 0 0.12 0 5 100 0 2 13
Telur
bumbu
bali Telur ayam 60 97.2 7.68 0 6.9 0.42 32.4 108 1.62 540 0.06 0 94.8 106.8 330 0 44.4
Tempe
Balado kedele
tempe murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16

Bobor Bayam 40 14.4 0 1.4 0.2 2.6 106.8 26.8 1.56 2436 0.032 32 1.6 166.4 0 1.4 34.76

Labu siam 20 5.2 0 0.12 0.02 1.34 2.8 5 0.1 4 0.004 3.6 0 0 0 0.6 18.46

malam Nasi Beras giling 100 360 0 6.8 0.7 78.9 6 140 0.8 0 0.12 0 5 100 0 2 13
Balado
tuna Ikan segar 25 28.25 4.25 0 1.125 0 5 50 0.25 37.5 0.0125 0 25.125 75 0 0 19
Rempah
tahu Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4

Sup Wortel 25 10.5 0 0.3 0.075 2.325 9.75 9.25 0.2 3000 0.015 1.5 17.5 61.25 0 1.25 22.05

Kentang 25 20.75 0 0.5 0.025 4.775 2.75 14 0.175 0 0.0275 4.25 1.75 99 0 0.625 19.45

Kapri muda 10 4.2 0 0.33 0.02 0.9 5.1 8.5 0.1 44 0.02 1.9 0.1 37 0 0 8.68
Total
1538 60.86 33.745 246.92 345.2 879.35 13.45 11651 0.773 50.15 280.375 1665.45 375 18.215 431.005
Lampiran 10. Monitoring dan Evaluasi Pasien 3 (27 Februari 2019)

Bahan Protein
Waktu Menu Berat Energi LEMAK HA Ca Fosfor Fe Vit. A Vit. B1 Vit. C Natrium Kalium Coles Serat AIR
Makanan
Hewani Nabati

Pagi Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5
Ayam
rica-rica 50 151 9.1 0 12.5 0 7 100 0.75 405 0.04 0 50 175 30 0 27.95
Tahu
goreng Tahu 25 17 0 1.95 1.15 0.4 31 15.75 0.2 0 0.015 0 3 37.75 0 0.125 21.2
Cah
wortel
sawi
putih Wortel 10 4.2 0 0.12 0.03 0.93 3.9 3.7 0.08 1200 0.006 0.6 7 24.5 0 0.5 8.82

Sawi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pisang
Snack Pisang ambon 75 74.25 0 0.9 0.15 19.35 6 21 0.375 109.5 0.06 2.25 13.5 325.5 0 2.25 54

Siang Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75
Ayam
bumbu
koloke Ayam 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sambel Tempe
goreng kedele
tempe murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16
Sup
sehat Wortel 25 10.5 0 0.3 0.075 2.325 9.75 9.25 0.2 3000 0.015 1.5 17.5 61.25 0 1.25 22.05

Buncis 25 8.75 0 0.6 0.05 1.925 16.25 11 0.275 157.5 0.02 4.75 8.8 19.425 0 2.375 22.225
Kol
kembang 25 6.25 0 0.6 0.05 1.225 5.5 18 0.275 22.5 0.0275 17.25 7.5 87.25 0 1.625 22.925

malam Nasi Beras giling 100 360 0 6.8 0.7 78.9 6 140 0.8 0 0.12 0 5 100 0 2 13
Telur
bumbu
kare Telur ayam 30 48.6 3.84 0 3.45 0.21 16.2 54 0.81 270 0.03 0 47.4 53.4 165 0 22.2
Bistik
tahu Tahu 50 34 0 3.9 2.3 0.8 62 31.5 0.4 0 0.03 0 6 75.5 0 0.25 42.4
Lodeh
kacang
panjang
labu
siam Labu siam 20 5.2 0 0.12 0.02 1.34 2.8 5 0.1 4 0.004 3.6 0 0 0 0.6 18.46
Kacang
panjang 20 8.8 0 0.54 0.06 1.56 9.8 69.4 0.14 67 0.026 4.2 1.04 11.084 0 1.36 17.7

Total
1215.8 41.845 22.41 210.765 215.95 692.1 7.905 5248 0.586 34.15 172.99 1095.659 195 16.585 325.18
Lampiran 11. Monitoring dan Evaluasi Pasien 3 (28 Februari 2019)

Protein
Waktu Menu Bahan Makanan Berat Energi LEMAK H A Ca Fosfor Fe Vit. A Vit. B1 Vit. C Natrium Kalium Coles Serat AIR
Hewani Nabati

Pagi Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Kare ayam 75 226.5 13.65 0 18.75 0 10.5 150 1.125 607.5 0.06 0 75 262.5 45 0 41.925

Tempe bumbu bali Tempe kedele murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16

Cah tauge wortel Wortel 40 16.8 0 0.48 0.12 3.72 15.6 14.8 0.32 4800 0.024 2.4 28 98 0 2 35.28

Tauge kacang kedele 20 13.4 0 1.8 0.52 1.28 10 13 0.2 22 0.046 3 0 0 0 1.18 16.2

Snack Pisang Pisang ambon 100 99 0 1.2 0.2 25.8 8 28 0.5 146 0.08 3 18 434 0 3 72

Siang Nasi Beras giling 50 180 0 3.4 0.35 39.45 3 70 0.4 0 0.06 0 2.5 50 0 1 6.5

Telur bumbu bali Telur ayam 30 48.6 3.84 0 3.45 0.21 16.2 54 0.81 270 0.03 0 47.4 53.4 165 0 22.2

Balado tempe Tempe kedele murni 25 37.25 0 4.575 1 3.175 32.25 38.5 2.5 12.5 0.0425 0 0 0 0 1.75 16

Bobor Bayam 30 10.8 0 1.05 0.15 1.95 80.1 20.1 1.17 1827 0.024 24 1.2 124.8 0 1.05 26.07

Labu siam 20 5.2 0 0.12 0.02 1.34 2.8 5 0.1 4 0.004 3.6 0 0 0 0.6 18.46

malam Nasi Beras giling 75 270 0 5.1 0.525 59.175 4.5 105 0.6 0 0.09 0 3.75 75 0 1.5 9.75

Balado tuna Ikan segar 40 45.2 6.8 0 1.8 0 8 80 0.4 60 0.02 0 40.2 120 0 0 30.4

Rempah tahu Tahu 25 17 0 1.95 1.15 0.4 31 15.75 0.2 0 0.015 0 3 37.75 0 0.125 21.2

Sup Wortel 10 4.2 0 0.12 0.03 0.93 3.9 3.7 0.08 1200 0.006 0.6 7 24.5 0 0.5 8.82

Kentang 10 8.3 0 0.2 0.01 1.91 1.1 5.6 0.07 0 0.011 1.7 0.7 39.6 0 0.25 7.78

Kapri muda 10 4.2 0 0.33 0.02 0.9 5.1 8.5 0.1 44 0.02 1.9 0.1 37 0 0 8.68

Total
1293.7 54.29 29.62 202.59 268.8 755.45 11.675 9005.5 0.665 40.2 230.6 1431.55 210 16.205 367.015