Laserfiche WebLink
TITLE III-C CONgREGATE/HOME DELIVE~n NUTRITION <br /> MENU _r~N~E FORM <br /> <br />County Menu Date <br />Dates New Menu Will Be Used: <br /> <br /> CURRENT PROPOSED <br /> MENU MENU <br />MAIN EIFfREE <br />PROTEIN SOURCE <br />2 OZ. <br />VEGETABLES & FRUITS <br />2-1/2 CUP SERVINGS ...................... <br />BREAD AND COMPLEX CARBOHYDRATES <br />2 SERVINGS ...................... <br />FAT <br />DESSERT <br />1/2 CUP ." <br />MILK OR CALCIUM <br />1/2 PINT <br /> <br />Signature of Person Completing Form Date <br />Signature of Nutrition Program Director Date <br />Reason for Change <br /> <br />REGISTERED DIETITIAN APPROVAL: I CERTIFY THAT THE ABOVE CHANGE MEETS 1/3 RDA <br />AND THE MEAL PATTERN AS SET BY THE NCDOA SERVICE STANDARDS. (Please check <br />appropriate blank.) <br /> <br />YES, MEETS STANDARDS NO, DOES NOT MEET STANDARDS <br /> <br />SIGNATURE OF REGISTERED DIETITIAN RD# DATE <br /> <br />SIGNATURE OF AAA ADMINISTRATOR DATE RECEIVED DATE REVIEWED <br /> <br />Revised 7/99 Submit for. AAA review prior to first date of change. <br />iiicform <br /> <br /> <br />