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...At etitian i d three day food diary our y o it t send r tmen in re appo n tritio staple he nu s u ner is rt h a x top b please return healthpnutrition services mail spminneapolis mn healthpartners referring provider umed registered dietitian unt co to be completed by reason for requesting analysis amo action desired check least one box results follow up with patient rage e call discuss appointment has been referred nutrition consult date or bev home clinic member time name address telephone work age height weight male female pregnant breast feeding are you following special diet describe health and concerns exercise activity level indicate type length of frequency example walk minutes four times week do take any medications supplements over the counter prescription yes no if list include amounts directions complete your read carefully record everything eat drink even water entire days choose when have eaten as usual weekend pattern different from weekday meals make sure that saturday s...