Clemens Health | Meal choice to shopping list practice sheet
Updated 2026-10-05 | (651) 354-1196

Choose an appropriate familiar meal with the person. Use this to plan a learning conversation, not as dietary advice or a food-safety procedure.

Person's choice
What meal or planning task do they want to work on?
Illustrative entry: Choose ingredients for one familiar lunch.
Your notes: ________________________________________

Current strength
What part do they already manage?
Illustrative entry: Selects the meal and recognizes usual ingredients.
Your notes: ________________________________________

Practice step
Which one decision will be practiced?
Illustrative entry: Check what is available before adding items to the list.
Your notes: ________________________________________

Inventory states
How will available, uncertain and missing items be recorded?
Illustrative entry: Three labeled sections on a short paper list.
Your notes: ________________________________________

Agreed assistance
What will the worker demonstrate or help with?
Illustrative entry: Ask how the person wants help checking an uncertain item.
Your notes: ________________________________________

Observation
What did the person actually do?
Illustrative entry: Moved a checked item from uncertain to available.
Your notes: ________________________________________

Next attempt
What does the person want to repeat or change?
Illustrative entry: Use the same short list in the next agreed practice.
Your notes: ________________________________________

Illustrative example
A person chooses a familiar lunch and begins a shopping list. They know one ingredient is available but are unsure about another. Rather than adding both to the list, they use the “needs checking” section and verify the uncertain item with agreed assistance. The review records that decision, not whether the entire meal was prepared independently. The person asks to keep the three-section list for the next attempt. This gives the provider a concrete planning skill to discuss without claiming a clinical or financial outcome.

Next step
Bring one chosen meal-planning step and the current assistance level to the provider and case manager when discussing the learning goal.

This is an optional discussion worksheet, not an official assessment, authorization, service plan, or emergency plan. Keep completed copies private and share through an agreed channel.