FLT Plan of Care (POC) Date* MM slash DD slash YYYY Name* Program Goal(s)* Short Term Goal* DietPlease check what applies.* 1300 calorie 1600 calorie 1800 calorie 2000 calorie 2200 calorie 2400 calorie Meal Replacement Servings Daily (enter below) Enter # of servings daily, if checked above.* ExerciseWalking*Select FrequencyDaily5x Week3x WeekHow long? Stretching*Select FrequencyDaily5x Week3x WeekHow long? Other Aerobic*Select FrequencyDaily5x Week3x WeekHow long? Weight Training*Select FrequencyDaily5x Week3x WeekHow long? Nutritional SupplementsProduct #1* Check options that apply.* Breakfast Mid AM Lunch Mid PM Dinner Product #2 Check options that apply. Breakfast Mid AM Lunch Mid PM Dinner Product #3 Check options that apply. Breakfast Mid AM Lunch Mid PM Dinner Product #4 Check options that apply. Breakfast Mid AM Lunch Mid PM Dinner Product #5 Check options that apply. Breakfast Mid AM Lunch Mid PM Dinner Product #6 Check options that apply. Breakfast Mid AM Lunch Mid PM Dinner Product #7 Check options that apply. Breakfast Mid AM Lunch Mid PM Dinner
