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Health Care
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(1) My most recent physical exam (includes mammogram for women and prostate exam for men) was:
- Within the past six months
- Within the past year
- More than one year ago
If it has been over a year, my goal is to schedule an appointment by:
(2) My most recent dental exam was:
- Within the past six months
- More than six months ago
If it has been more than six months, my goal is to schedule an appointment by:
(3) I had my cholesterol checked on:
(4) I had my body fat percentage measured on:
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Diet
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(1) Diet checklist:
The USDA recommends:
- around 15% from chicken, fish, beef, pork, dry beans, eggs or nuts;
- around 40% from breads, rice, cereal or pasta;
- around 15% from fruits;
- around 20% from vegetables; and
- to use fats, oils and sweets sparingly
My typical diet consists of:
- Percentage of chicken, fish, beef, pork, dry beans, eggs or nuts:
- Percentage of breads, rice, cereal or pasta:
- Percentage of fruits:
- Percentage of vegetables:
- Percentage of fats, oils and sweets:
(2) Steps I can take to improve my diet:
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Exercise
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(1) I engage in ______ minutes of aerobic exercise per week (Includes walking, jogging, swimming, cycling or other cardiovascular activities)
(2) The intensity of my aerobic exercise is light, moderate, or intense.
(3) I do stretching exercises for _____ minutes per week.
(4) I lift weights (or do other strengthening exercise) for _____ minutes per week.
(5) I plan to increase my physical activity as follows:
(It is wise to meet with your doctor and/or a personal trainer before engaging in brand-new activities or increasing too many things at one time.)
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