DAILY INFANT MENU PRODUCTION RECORD FOR 8 – 11 …



DAILY INFANT MENU PRODUCTION RECORD FOR 8 – 11 MONTH OLD INFANTS DATE: _______________

1) Record date (month/day/year).

2) Record the name & birthdate of each infant.

3) Specify the name of the formula (Document the brand of formula for each meal/snack when different from the formula listed for the infant).

4) Record if the infant is receiving formula, expressed breast milk “EB”, or is breastfed “BF” for each meal/snack.

5) Record actual food offered for each meal/snack (examples: peaches, apple juice, rice cereal).

6) Designate food and/or formula supplied by parent/guardian for each meal/snack as parent supplied, “PS”. Example: “PS, peaches”.

| |BREAKFAST |LUNCH OR SUPPER |AM or PM SNACK |

| | | | |

|NAME OF INFANT | | | |

|Birthdate | | | |

|Brand of Formula | | | |

| |Formula, Breast milk 6-8 oz |Infant |Veg. and/or Fruit |Complete|Formula or Breast milk 6-8 oz |Veg. |

| | |Cereal |1-4 Tbsp |Breakfas| |and/or |

| | |2-4 Tbsp| |t Served| |Fruit |

| | | | | | |1-4 Tbsp. |

| | | | | | | |

DAILY INFANT MENU PRODUCTION RECORD FOR 4 – 7 MONTH OLD INFANTS DATE: _______________

1) Record date (month/day/year).

2) Record the name & birthdate of each infant.

3) Specify the name of the formula (Document the brand of formula for each meal/snack when different from the formula listed for the infant).

4) Record if the infant is receiving formula, expressed breast milk “EB”, or is breastfed “BF” for each meal/snack.

5) Record actual food offered for each meal/snack (examples: peaches, apple juice, rice cereal).

6) Designate food and/or formula supplied by parent/guardian for each meal/snack as parent supplied, “PS”. Example: “PS, peaches”.

| |BREAKFAST |LUNCH OR SUPPER |AM or PM SNACK |

| | | | |

|NAME OF INFANT | | | |

|Birthdate | | | |

|Brand of Formula | | | |

| |Formula or Breast milk |(optional) |Complete Breakfast Served |Formula or |(optional) |(optional) |

| |4-8 oz | | |Breast milk | | |

| | |Infant Cereal| |4-8 oz |Infant |Veg. and/or |

| | |0-3 Tbsp. | | |Cereal |Fruit |

| | | | | |0-3 Tbsp. |0-3 Tbsp. |

DAILY INFANT MENU PRODUCTION RECORD FOR 0 – 3 MONTH OLD INFANTS DATE: ___________

1) Record date (month/day/year).

2) Record the name & birthdate of each infant.

3) Specify the name of the formula (Document the brand of formula for each meal if different from the formula listed for the infant).

4) Record if the infant is receiving formula, expressed breast milk “EB”, or is breastfed “BF” for each meal or snack.

5) Designate formula supplied by parent/guardian for each meal or snack as parent supplied, “PS”. Example: “PS, Enfamil”.

BREAKFAST AM SNACK LUNCH PM SNACKDINNER NAME OF INFANT

Birthdate

Brand of Formula



Formula or Breast milk

4-6 ozComplete Breakfast Served

Formula or Breast milk

4-6 ozComplete AM Snack Served

Formula or Breast milk 4-6 ozComplete Lunch Served

Formula or Breast milk

4-6 ozComplete PM Snack Served

Formula or Breast milk

4-6 ozComplete Dinner Served_________________

Birthdate: _____________

Formula: _______________________________

Birthdate: _____________

Formula: _______________________________

Birthdate: _____________

Formula: _______________________________

Birthdate: _____________

Formula: _______________________________

Birthdate: _____________

Formula: ______________Reimbursable MealsBreakfastAM SnackLunchPM SnackDinner

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