ABCDEFGHIJKLMNOPQRSTUVWXYZAA
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Country and Coach name
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Seafarers Number
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Name of Maritime Clinic
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To be completed by the seafarer every week:
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Year 2023-2024Week 1Week 2Week 3Week 4Week 5Week 6Week 7Week 8Week 9Week10Week11Week12Week13Week14Week15Week16
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Did you improve compared to the weeks before
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How was your week? (good, not so good) G/Ng
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Taking diabet medicine? n
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Taking blood pressmedicine? n
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Weight kg85
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Goal weight kg80
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Goal 1 Do more Phys activity
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Goal 1 was obtained last week ? Y/NN
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Goal 2 Eating less high calory meals
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Goal 2 obtained last week ? Y/NN
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Goal 3 Eating more fruit, vegetables
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Goal 3 obtained last week ? Y/NY
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Goal 4 Taking less snacks and coca-cola
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Goal 4 obtained last week ?Y/NY
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Fasting fingerpr Blood Sugar mg/dl (Saturday)142
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Diastolic Blood Pressure88
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Systolic Blood pressure142
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Goal 5 use more time for reading
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Goal 5 obtained last week ? Y/Nn
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Were you: at home or at sea last week (H/S)?S
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The learning materials are good/not good (G/N)G
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Propose other good materials for learning:
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Clinic Health examinationsNormalStart4month
12 month
2 years
Total daily minutes of physical activity
Goals to change to more minutes each day
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DateWalkRunGym*WorkWalkRunGym*Work
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Gen (M/F)M------
Mondays
400030
Mondays
00200
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Age24------
Tuesdays
0000
Tuesdays
0000
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Work (Fishing, Merchant (F/M)F------
Wednesdays
0000
Wednesdays
0000
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Tobacco Y/NY
Thursdays
0000
Thursdays
0000
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Fasting fingerpr Blood Sugar142Fridays0000Fridays0000
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HbA1C %6,2%
Saturdays
0000
Saturdays
0000
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Hight cm 180
Sundays
0000
Sundays
0000
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Taking diabet medicine? Y/NN
"Gym" = gym, swimmingpool, sport or whatever
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Taking blood press medicine? Y/N N
"Work" = all types of phys. activity at home and workplace, partwise "strong" = elevated pulse rate
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Weight kg85
How much exercise time is "strong" with elevated pulse rate in % ?
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BMI26.2
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Total Cholesterol
Will you be able to follow these simple meal plans?
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LDH (low-density lipoprotein -not good )
1. Fill half of your plate with vegetables such as broccoli, green beans, carrots, and cauliflower.
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HDL (high-density lipoprotein -good one)
2. A quarter of your plate should be a low-fat protein, like skinless chicken, turkey, or leaner cuts of beef or pork.
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TG Triglycerides
3. For the final quarter, choose whole grains like brown rice, high-protein quinoa, or farro. Avoid “simple” grains like pasta and white rice.
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Body circumference cm
4. Stay away from high-sugar sodas and juices. Opt for low fat milk or water.
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Yes, i do that Y/N
y
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No, but Will try to Y/N
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