(Affix patient identification label here)
URN:
Royal Brisbane & Women’s Hospital
Family Name:
QUEENSLAND EATING
Given Names:
DISORDER SERVICE
Address:
(QuEDS) WEIGHT CHART
Date of Birth:
Sex:
M
F
I
Admission Date:
/
/
Height:
m
Instructions for weight recording
...........
.............
...........
........................
•
Consumer dressed in gown and underwear
Admission Weight:
kg Height ²
m
•
.............................
...............
Weigh first thing in the morning after voiding
•
Admission BMI:
Specific Gravity required each weigh,
.........................................
<1.010 indicates dilute urine
Goal Weight Range:
kg Goal BMI:
..........................
.........................
•
Please see over the page for further notes
To complete plot BMI on dotted line.
Note BMI = weight (kg) ÷ height ² (m)
24
23
22
21
20
19
18
17
16
15
14
13
12
11
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
SG
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Page 1 of 2