EFTA00073904

# Bureau of Prisons
Health Services
Modified Diet Request

# Types of Diets:

___ Clear Liquid Exp Date:
___ Low Fat Exp Date:
___ Mechanical Soft Exp Date:
___ Low Cholesterol Exp Date:
___ Low Triglyceride Exp Date:
___ Renal Exp Date:
___ Full Liquid Exp Date:
___ Sodium Controlled Exp Date:
___ Snack Exp Date:
___ Diabetic Exp Date:
___ Calorie Controlled Exp Date:

**X Other:** FISH ALLERGIES. Exp Date: 07/30/2020

Comments:

Page 074 of 148

Withheld pursuant to exemption

of the Freedom of Information and Privacy Act

Reg#

<table border="1"><tr><td>07/30/2019</td></tr><tr><td>Date</td></tr></table>

Generated 07/30/2019 14:57 by

Bureau of Prisons - NYM

Page 1 of 1