MDMP TRACKING SHEET 'Send this form via HIPAA compliant manner to Alice Chan at AliceChan@umm.edu by the 5th business day of each month 

'Fill out these sections as they pertain to your hospital. 

Patient 

# 

Patient 

First Name 

Patient 

Last Name 

Medical 

Record 

Number 

Admission 

Date 

Discharge 

Date Referred By Insurance Provider Referral Criteria Met List Diagnosis 

Diet Type (only 

choose ONE) 

Initial Meal Package 

Days of

meals Location Date 

Follow-U

Location 

0 Example Template 1234567 9/10/18 9/16/18 Sally Jones. 

Case Manager Aetna 

✓ Specific diagnosis

Food insecurity 

✓ Malnutrition 

✓ T2DM 

CHF 

COPD 

✓ CO'HH 

Enhanced Healina Hospital 

Discharge 3 9/16/18 

✓ Home Visit 

Care Clinic 

AAA 

CO'HH 

1 Enhanced Healina 

CO'HH 

2 Enhanced Hea/ina 

CO'HH 

3 Enhanced Healing 

CO'HH 

4 Enhanced Hea!ina 

CO'HH 

5 Enhanced Healing 

CO'HH 

6 Enhanced Healina 

CO'HH 

7 Enhanced Healina 

CO'HH 

8 Enhanced Hea/ina 

CO'HH 

9 Enhanced Healing 

CO'HH 

10 Enhanced Healina 

CO'HH 

11 Enhanced Healino 

CO'HH 

12 Enhanced Healing 
 

 

 

 

 

MARYLAND DISCHARGE MEAL PROGRAM PILOT: ORDERING INSTRUCTIONS 

Package sizes: Outer package dimension – 15.5”x 11.5”x 11.5”

Weight per box – 22-24 lbs. for 6 days box 

Weight per bag – 11-12 lbs for each cloth grocery bag 

 Note: Enhanced Healing package will be slightly heavier than Carb-Controlled/Heart-Healthy 

Order processing for the pilot follows: 

Deliveries will occur on Thursdays and Fridays, so please place orders no later than Tuesdays at 

10:30AM. 

Delivery windows: either 8-12PM or 12-4PM 

Minimum order size: 20 boxes 

Note: Orders will be standardized to a 50/50 split of each of the 2 diet types (1⁄2 Carb-Controlled/HeartHealthy and 1⁄2 Enhanced Healing) 

Please send email orders to Tracey, the main contact, and cc Jessica, Zak, and Gary. 

Email address: Tracey Ivison (Partner Services Supervisor) - tivison@mdfoodbank.org 

Jessica Corcelius (Partner Services Director) – jcorcelius@mdfoodbank.org 

Zak Jeffries (Warehouse Manager) - zjeffries@mdfoodbank.org 

Gary Melvin (Transportation Manager) – gmelvin@mdfoodbank.org 

Email is the best and most effective way to contact the team however phones are: 

Tracey Ivison – 443.297.5180 

Jessica Corcelius 443.297.5193 

Zak Jeffries - 443.297.5207 

Gary Melvin – 443.297.5149 

Email instructions: 

Email subject line: Maryland Discharge Meal Program New Order 

Email should include: 

 Desired delivery date 

 Delivery location 

 Quantity of boxes 
Day 1 3

Day 2

Day 4 Day 6

Day 5

                                               

What’s in your

Box?

Boxes either contain:

Carb‐Controlled,

Heart‐Healthy

meal plan

Enhanced

Healing

meal plan

or

Each patient only gets one type of meal plan

Use the Patient Selection Flowsheet to help you determine which meal plan is right for your patient

Day

Provide tote bags to the patients

Each patient gets four (4) bags

total (12 days of food) – an

initial set of bags at discharge

and the remainder at follow‐up

A B
           

           

           

         

                         

       

             

         

           

                 

           

       

       

         

       

       

         

       

   

           

                                 

                                      

                     

                               

Your patient will either get a Carb‐Controlled, Heart‐

Healthy or a Enhanced Healing meal package plan.

Here are the differences between the two:

Carb‐Controlled, Heart‐Healthy

• Calorie range 1500 – 1700 per day

• Carbohydrates are 45‐55% of total

calories in accordance with the

adult Dietary Reference Intake*

• Carbohydrates are spread evenly

between meals.

• Meals are about 3‐4 carb choices each

and snacks are 1‐2 carb choices.

• Moderate total fat (25 – 33% of

total calories)

• Adequate protein for maintaining

muscle (18 – 20% of total calories)

• Sodium is under 2,000 mg per day

Enhanced Healing

(high energy & high protein)

• Higher calories for medical

conditions that use more energy

(1900 – 2500 Calories per day)

• Adequate protein for maintaining

muscle (over 100 grams per day)

• No restrictions on fat,

carbohydrates, or sodium

Additional information for both meal package plans: 

• Easy to prepare.  Requires:

• Spreading with a knife

• Opening a can

• Pulling off a cap

• Mixing

• Puncturing with a straw

• Pulling open a package

• Additional kitchen items required:

• Water

• Bowls & plates

• Forks, knives & spoons

• Can opener

• Microwave

• Optional: scissors (if patient has

difficulty opening packages)

Grant funds from the Administration for Community Living (ACL) and the Maryland Department of Aging assisted in

the development of this material. Points of view or opinions contained herein are those of the authors and do not

necessarily represent the official position or policies of the ACL or Department.

*SOURCE: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005).

https://www.ncbi.nlm.nih.gov/books/NBK56068/table/summarytables.t5/?report=objectonly
MDMP Patient Selection Flowsheet 

Start Is My Patient Eligible? 

Does your patient have any of the following orders at time of discharge? 

- A sodium restriction of less than 2000mg per day? 

A fluid restriction of less than 1500mL per day? 

A potassium, phosphorous or protein restriction 

A modified texture diet order 

-

-

-

No to all Yes to any 

Your patient is not eligible for meal packages.* 

Is any of the following true about your patient at time of discharge? 

-

-

-

Patient is being discharged to a facility that provides more than seven (7) 

meals per week (assisted living facility, skilled nursing facility, etc.) 

Patient has a diagnosed food allergy 

Patient has Celiac Disease 

No to all Yes to any 

Your patient is not eligible for meal packages.*

 Is any of the following true about your patient at time of discharge? 

-

-

Patient has no access to refrigeration or storage space (i.e. patient does not 

have a place of residence) 

Patient has an active substance addiction (including alcohol) and is not 

currently in active treatment 

No to all Yes to any 

Your patient is not eligible for meal packages. 

Please see the Community Referral Handout for 

more options. 

Is your patient older than 50? 

Yes No 

Your patient is not eligible for meal packages. 

Please see the Community Referral Handout for 

more options. 

* Please contact your inpatient dietitian for further evaluation if you have any questions or if you are unsure of patient eligibility. 

Provide this flowsheet to the dietitian and nutritional information for meal packages found on the back. 

Which Meal Package Plan? 

Patient has higher nutritional needs based on 

medical condition. This includes: 

-

-

-

COPD diagnosis 

Positive malnutrition risk screen or malnutrition 

diagnosis 

Order for dietary supplements 

Patient has need for diabetes diet and/or 

heart-healthy diet OR has no dietary restrictions 

(regular diet order) 

Provide patient with the 

Enhanced Healing

Meal Package 

Provide patient with the 

Carb-Controlled, Heart-Healthy 

Meal Package 

Grant funds from the Administration for Community Living (ACL), Grant Number 90INNU0002-02-01 and the Maryland 

Department of Aging assisted in the development of this material. Its contents are solely the responsibility of the 

authors and do not necessarily represent the official position or policies of the ACL or Department. 
Lunch rinneD nacksS 1 saltTo

tsfakaerB

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Corn Flakes, Fruit Cup, Granola Bar, Milk 

Oatmeal, Craisins, Granola Bar, Milk 

Cereal, Craisins, Granola Bar, Milk Corn Flakes, Fruit Cup, Granola 

Bar, Milk 

Cereal, Fruit Cup, Granola Bar, Milk 

Oatmeal, Raisins, Granola Bar, Milk 

unchL

Tuna, Crackers, Tomato Soup, Mayo Packet 

Rice & Quinoa, Corn Cup, Salsa, 

Protein Bar 

Tuna, Corn Cup, Vegetable Soup, 

Crackers, Peanut Butter 

Chicken, Crackers, Chicken Noodle Soup 

Tuna, Crackers, Tomato Soup, Peanut butter 

Rice & Quinoa, Corn Cup, Vegetable Soup, Yogurt 

rneniD Pasta, Chicken, Green Bean Cup, Yogurt Chicken, Raisins, Crackers, Mayo Packet, Carrot Cup, Chocolate Milk Salmon, Mac & Cheese, Green Bean Cup Rice & Quinoa, Tuna, Green Bean Cup, Mayo Packet, Yogurt Chicken, Mac & Cheese, Carrot Cup Salmon, Pasta, Carrot Cup, Mayo Packet sacknS Pretzels, Peanut Butter, Chocolate Milk, Ensure, Protein Bar Pretzels, Peanut Butter, Ensure, Applesauce, Yogurt Fruit Cup, Yogurt, Protein Bar, Fruit Snacks, Ensure Applesauce, Ensure, Chocolate Milk, Protein Bar Fruit Snacks, Yogurt, Ensure, Applesauce, Protein Bar Fruit Cup, Ensure, Protein Bar, Crackers, Peanut Butter 

1 salotT Kcal Pro Fat CHO Na+ K+ 2430 123 75 334 2850 2789 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 

2360 99 76 322 2740 2895 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 2018 110 65 265 2565 2507 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1970 105 58 274 2270 2684 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 2018 106 67 266 2365 2499 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 2430 105 77 334 2465 2750 

g g g mg mg 

Carb-Controlled, Heart-Healthy 

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 

tsfaakerB Corn Flakes, Fruit Cup, Granola Bar, Milk 68g of Carbs Oatmeal, Granola Bar, Milk 46g of Carbs Cereal, Craisins, Milk 64g of Carbs Corn Flakes, Fruit Cup, Granola Bar, Milk 68g of Carbs Cereal, Fruit Cup, Milk 58g of Carbs Oatmeal, Granola Bar, Milk 46g of Carbs 

Crackers, Tuna, Tomato Soup, 

Mayo Packet 

45g of Carbs 

Pasta, Chicken, Green Bean Cup, Yogurt 

60g of Carbs 

Crackers, Peanut Butter 

33g of Carbs 

Rice & Quinoa, Corn Cup, Salsa, Protein Bar 

68g of Carbs 

Raisins, Chicken, Carrot Cup, Mayo 

Packet, Crackers 

48g of Carbs 

Fruit Snacks, Yogurt, Applesauce 

54g of Carbs 

Tuna, Corn Cup, Vegetable Soup, Crackers, Peanut Butter 

53g of Carbs 

Salmon, Pasta, Green Bean Cup, Mayo Packet 

45g of Carbs 

Fruit Cup, Yogurt, Granola Bar 

46g of Carbs 

Chicken, Crackers, Chicken Noodle Soup, Carrot Cup, Craisins 

57g of Carbs 

Pasta, Tuna, Green Bean Cup, 

Mayo Packet 

44g of Carbs 

Yogurt, Applesauce, Raisins 

57g of Carbs 

Crackers, Tuna, Tomato Soup, Peanut Butter 

56g of Carbs 

Chicken, Raisins, Crackers, Mayo Packet, Carrot Cup 

48g of Carbs 

Applesauce, Yogurt, Granola Bar 

49g of Carbs 

Rice & Quinoa, Vegetable Soup 

57g of Carbs 

Salmon, Pasta, Green Bean Cup, Mayo Packet 

45g of Carbs 

Yogurt, Fruit Snacks, Protein Bar 

51g of Carbs 

Kcal Pro Fat CHO Na+ K+ 1630 76 62 206 2035 1875 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1560 70 47 216 1850 1779 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1598 79 57 208 1890 2018 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1480 68 39 226 1855 1743 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1598 71 60 211 1685 2269 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1520 78 44 199 1545 1486 

g g g mg mg 

Enhanced Healing (high-protein, high-energy) 

1Nutrition facts are estimates based on most accurate data and may not reflect the exact nutritional makeup of the meal packages. Days 1-3 and Days 4-6 are packaged together and a client may not eat everything in 

the exact order as described on this page. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 _______________________________________________________ 

Maryland Discharge Meal Program Pilot: Acknowledgement & Authorization 

Purpose & Background 

The first two weeks following a discharge from a hospital are very important for recovery. Many patients are at 

high risk for poor nutrition and readmission to the hospital during this time. The Maryland Discharge Meal Pilot 

Program is intended to help smooth the transition from hospital to home and to improve the nutritional status of 

the patients selected by the participating hospital for the pilot. 

The Program includes 12 days of medically tailored, shelf-stable food paid for by the Maryland Department of 

Aging via a grant from the federal Administration for Community Living. The Maryland Food Bank assembles 

the food packs for the Program. The initial pack of food will be provided by the hospital upon discharge and the 

second pack of additional food will be available for pickup at a follow-up visit or delivered during a home visit. 

Participating individuals will be asked to reply to an anonymous client feedback survey. 

Not all patients are medically eligible for this meal program. Eligibility criteria is included in the Patient 

Selection Flowsheet. 

I understand, acknowledge, and agree that: 

1. I am receiving the initial food pack from the hospital discharging me, 

2. I will pick up (or if the hospital so provides, receive) the second pack, 

3. My discharging hospital has discussed this pilot program with me in detail and explained to me where I 

have to go and what I have to do to pick up the second pack, 

4. I have discussed the eligibility criteria and have disclosed any relevant information to the hospital, 

5. This program does not deal with emergency situations and if I need immediate help, I will call 911, 

6. This is a voluntary program, 

7. At any time, I have the right to revoke my consent to the release of information I have provided below, 

and that, in any event, my consent will expire one year from the date I sign this acknowledgement, and 

8. There is no cost to participate, but the food provided is for my consumption alone and must not be given 

or sold to others. 

Client Authorization for Release of Information 

I consent to: 

1. The hospital contacting me in person, by telephone, or by mail for a follow up feedback survey, 

2. The hospital sending the results of the survey in an anonymous* fashion so that my identity is not 

disclosed, to the Maryland Department of Aging, 

3. My discharging hospital sharing certain anonymous* information with the Maryland Department of 

Aging so the Department can know what food packs have been provided by hospitals and been picked 

up by participants, and 

4. My discharging hospital sharing certain health information developed by the hospital with the 

University of Maryland St. Joseph Medical Center so the effectiveness of the pilot can be evaluated. 

*Anonymous means no personally identifying information, such as name or address, is reported and all data is 

reported in a summary format so no individual can be identified. 

I have read this and understand it. If there were parts I did not understand, I asked questions and had it 

explained to me. 

Name of Patient (Printed) 

Signature of Patient Date 

Name of Discharging Hospital 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you need food or other support.... 

These 

resources 

may help! 

Have you applied for SNAP? 

 “SNAP” stands for “Supplemental Nutrition Assistance

Program” - formerly known as food stamps. SNAP is a 

government program. You can apply directly to the 

state or get help with your application. The Maryland 

State Information/ Hotline Number is 1-800-332-6347. 

 Maryland Food Bank has a SNAP Outreach Team that 

can help with your application. Phone toll-free 1-888-

808-7327, Monday-Friday 8am to 5pm. 

Area Agencies on Aging provide a wide array of services to 

people 60 or older, including hot or cold home-delivered meals 

and group dining (senior center meals). To get connected with 

your local Area Agency on Aging, call the Maryland Department 

of Aging at 410-767-1100. 

Maryland Acccess Point (MAP) is a onestop source of information and assistance for 

long term services and supports. These include...

• Information on health 

• Transportation 

• Income and financial aid 

• Senior and community centers and clubs 

• Nutrition and meals 

• Pharmacy assistance 

• Housing 

• Volunteer opportunities 

• And more! 

Get connected by calling 1-844-627-5465 or go 

to www.MarylandAccessPoint.info 

Grant funds from the Administration for Community Living (ACL) and the Maryland Department 

of Aging assisted in the development in this material. Points of view or opinions contained 

herein are those of the authors and do not necessarily represented the official position or 

policies of the ACL or Department. 
These 

resources 

may help!

If you need food or other support....

Food Pantries want to help. 

To find a food pantry in your area: 

1. Go to the Maryland Food Bank website https://mdfoodbank.org 

2. Click on the words “Find Food” in the top right-hand corner. 

3. Scroll down, then click inside the grey box below the words “Address or Zip Code”

4. Enter your address or zip code, select the “within” miles and click on “Submit”

These 

resources 

may help! 

Other services can help by easing emotional or 

financial burdens in other parts of your life. 

The United Way has a free, confidential information and 

referral service. 

To get help, call 2-1-1, 24 hours a day, 7 days a 

week. 

If you can’t reach them by calling 2-1-1, use 

these numbers: 

• Greater Baltimore: 410-685-0525 

Elsewhere in Maryland 1-800-492-

0618 

TTY (for hearing impaired) 410-685-

2159 (weekdays 8:30am-4:45pm). 

You can also go to the website 

www.211md.org 

•

•

•
Day 1 

Day 2 

Nutritional Content Day 3 

Breakfast 

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch 

Tuna, Classic Tomato Soup, Wheat Crackers, 

Mayonnaise To-Go 

Dinner 

Barilla Pasta (1/2 bag), Premium Chicken (1/2 

can), Green Beans, Blended Yogurt 

Snacks 

Wheat Crackers, Natural Peanut Butter 

What’s in your

Bag? 

Carbohydrates 

190 – 220 grams per day 

45 – 70 grams per meal 

15 – 25 grams per snack 

Sodium 

1500 – 2000 mg/day 

Breakfast 

Quaker Oatmeal, PB & Dark Chocolate Granola Bar, 

Lowfat Milk 

Lunch 

Brown Rice & Quinoa, Sweet Corn, Picante Sauce, 

Chocolate Deluxe Protein Bar 

Dinner 

Premium Chicken (1/2 can), Raisins, Diced Carrots, 

Mayonnaise To-Go, Wheat Crackers 

Snacks 

Fruit Snacks, Blended Yogurt, Applesauce 

Breakfast 

Mini Wheats, Craisins, Lowfat Milk 

Lunch 

Tuna, Sweet Corn, Hearty Vegetable Soup, Wheat 

Crackers, Natural Peanut Butter 

Dinner 

Pink Salmon, Barilla Pasta (1/2 bag), Green Beans, 

Mayonnaise To-Go 

Snacks 

Mixed Fruit Cup, Blended Yogurt, PB & Dark 

Chocolate Granola Bar 

A Carb-Controlled, Heart-Healthy Meal Packages 
 

 

 

 

 

Carb-Controlled, Heart-Healthy 

Meal Packages 

The Carb-Controlled, Heart Healthy meal package is designed to 

provide you with the food you need to help you recover after your 

visit to the hospital. 

Balanced carbohydrates 

Carbohydrates (carbs) from the food you eat effect 

your blood sugar. These meals and snacks are 

balanced with the right amount of carbs to keep 

your blood sugar under control throughout the 

day. 

Pro Tip 

Be sure not to add any salt to 

these foods. Try other 

seasonings, like garlic powder, 

dried herbs, Mrs. Dash SaltFree seasoning, or other saltfree seasonings. 

Low salt 

Getting too much sodium 

(salt) can raise your blood 

pressure and be bad for your 

heart health. These meals 

are low in salt to keep your 

heart healthy and your blood 

pressure under control. 

Easy to prepare 

These foods were chosen because they are singleserve, easy to prepare, and can be kept at room 

temperature for up to six months. 

We want you to stay healthy once you leave the 

hospital. Enjoy these foods on us! 

In addition to these meal packages, you may also need: 

Water, bowls & plates, forks, knives & spoons, can opener, microwave, scissors 

Grant funds from the Administration for Community Living (ACL), Grant Number 90INNU0002 and the Maryland Department of Aging assisted in the development 

of this material. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACL or Department. 
Day 1 

Day 2 

Nutritional Content Day 3 

Breakfast 

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch 

Premium Chicken (1/2 can), Wheat Crackers, 

Hearty Chicken Noodle Soup, Diced Carrots, Craisins 

Dinner 

Barilla Pasta (1/2 bag), Tuna, Green Beans, 

Mayonnaise To-Go 

Snacks 

Blended Yogurt, Applesauce, Raisins 

What’s in your 

Bag? 

Carbohydrates 

190 – 220 grams per day 

45 – 70 grams per meal 

15 – 25 grams per snack 

Sodium 

1500 – 2000 mg/day 

Breakfast 

Mini Wheats, Mixed Fruit Cup, Lowfat Milk 

Lunch 

Tuna, Classic Tomato Soup, Wheat Crackers, 

Natural Peanut Butter 

Dinner 

Premium Chicken (1/2 can), Wheat Crackers, 

Raisins, Mayonnaise To-Go, Diced Carrots 

Snacks 

Applesauce, Blended Yogurt, PB & Dark Chocolate 

Granola Bar 

Breakfast 

Quaker Oatmeal, PB & Dark Chocolate Granola Bar, 

Lowfat Milk 

Lunch 

Brown Rice & Quinoa, Hearty Vegetable Soup 

Dinner 

Pink Salmon, Barilla Pasta (1/2 bag), Green Beans, 

Mayonnaise To-Go 

Snacks 

Blended Yogurt, Fruit Snacks, Chocolate Deluxe 

Protein Bar 

B Carb-Controlled, Heart-Healthy Meal Packages 
Carb-Controlled, Heart-Healthy 

Meal Packages 

The Carb-Controlled, Heart Healthy meal package is designed to 

provide you with the food you need to help you recover after your 

visit to the hospital. 

Balanced carbohydrates 

Carbohydrates (carbs) from the food you eat effect 

your blood sugar. These meals and snacks are 

balanced with the right amount of carbs to keep 

your blood sugar under control throughout the 

day. 

Pro Tip 

Be sure not to add any salt to 

these foods. Try other 

seasonings, like garlic powder, 

dried herbs, Mrs. Dash SaltFree seasoning, or other saltfree seasonings. 

Low salt 

Getting too much sodium 

(salt) can raise your blood 

pressure and be bad for your 

heart health. These meals 

are low in salt to keep your 

heart healthy and your blood 

pressure under control. 

Easy to prepare 

These foods were chosen because they are singleserve, easy to prepare, and can be kept at room 

temperature for up to six months. 

We want you to stay healthy once you leave the 

hospital. Enjoy these foods on us! 

In addition to these meal packages, you may also need: 

Water, bowls & plates, forks, knives & spoons, can opener, microwave, scissors 

Grant funds from the Administration for Community Living (ACL), Grant Number 90INNU0002 and the Maryland Department of Aging assisted in the development 

of this material. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACL or Department. 
Day 2 

Breakfast

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Wheat Crackers, Tuna, Classic Tomato Soup, 

Mayonnaise To-Go 

Dinner

Barilla Pasta, Premium Chicken (1/2 can), Green 

Beans, Blended Yogurt 

Snacks

Pretzels, Natural Peanut Butter, Chocolate Milk, 

Ensure Shake, Deluxe Chocolate Protein Bar 

What’s in your 

Bag? 

Breakfast

Quaker Oatmeal, Craisins, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Brown Rice & Quinoa, Sweet Corn, Picante Sauce, 

Deluxe Chocolate Protein Bar 

Dinner

Wheat Crackers, Premium Chicken (1/2 can), 

Raisins, Diced Carrots, Mayonnaise To-Go, 

Chocolate Milk 

Snacks

Pretzels, Natural Peanut Butter, Ensure Shake, 

Applesauce, Blended Yogurt 

Breakfast

Mini Wheats, Craisins, PB & Dark Chocolate Granola 

Bar, Lowfat Milk 

Lunch

Tuna, Sweet Corn, Hearty Vegetable Soup, Wheat 

Crackers, Natural Peanut Butter 

Dinner

Pink Salmon, Mac & Cheese, Green Beans 

Snacks

Mixed Fruit Cup, Blended Yogurt, Deluxe Chocolate 

Protein Bar, Fruit Snacks, Ensure Shake 

Day 1 

Day 3 

A Enhanced Healing Meal Packages 
Enhanced Healing 

Meal Packages 

The Enhanced Healing meal package is designed to provide you 

with the food you need to help you recover and stay strong after 

your visit to the hospital. 

High protein 

Protein helps keep your immune system strong, 

keep you from losing muscle, and helps wounds to 

heal. These foods give you enough protein to keep 

your muscles strong and to help you heal and 

recover after your hospital stay. 

High energy 

Eating a balanced diet and getting enough energy 

from your food is very important when you’re 

recovering. It can be hard to get enough to eat 

when you are sick, so these foods give you more 

energy in every bite. 

Easy to prepare 

These foods were chosen because they are singleserve, easy to prepare, and can be kept at room 

temperature for up to six months. 

We want you to stay healthy once you leave the 

hospital. Enjoy these foods on us! 

In addition to these meal packages, you may also need: 

Water, bowls & plates, forks, knives & spoons, can opener, microwave, scissors 

Grant funds from the Administration for Community Living (ACL), Grant Number 90INNU0002 and the Maryland Department of Aging assisted in the development 

of this material. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACL or Department. 
Day 2 

Breakfast

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Premium Chicken (1/2 can), Wheat Crackers, 

Hearty Chicken Noodle Soup 

Dinner

Brown Rice & Quinoa, Tuna, Green Beans, Blended 

Yogurt, Mayonnaise To-Go 

Snacks

Ensure Shake, Applesauce, Deluxe Chocolate Protein 

Bar, Chocolate Milk 

What’s in your 

Bag? 

Breakfast

Mini Wheats, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Tuna, Classic Tomato Soup, Wheat Crackers, 

Natural Peanut Butter 

Dinner

Premium Chicken (1/2 can), Mac & Cheese, Diced 

Carrots 

Snacks

Fruit Snacks, Blended Yogurt, Deluxe Chocolate 

Protein Bar, Applesauce, Ensure Shake 

Breakfast

Quaker Oatmeal, Raisins, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Brown Rice & Quinoa, Sweet Corn, Hearty Vegetable 

Soup, Blended Yogurt 

Dinner

Pink Salmon, Barilla Pasta, Diced Carrots, 

Mayonnaise To-Go 

Snacks

Mixed Fruit Cup, Ensure Shake , Deluxe Chocolate 

Protein Bar, Wheat Crackers, Natural Peanut Butter 

Day 1 

Day 3 

B Enhanced Healing Meal Packages
Enhanced Healing 

Meal Packages 

The Enhanced Healing meal package is designed to provide you 

with the food you need to help you recover and stay strong after 

your visit to the hospital. 

High protein 

Protein helps keep your immune system strong, 

keep you from losing muscle, and helps wounds to 

heal. These foods give you enough protein to keep 

your muscles strong and to help you heal and 

recover after your hospital stay. 

High energy 

Eating a balanced diet and getting enough energy 

from your food is very important when you’re 

recovering. It can be hard to get enough to eat 

when you are sick, so these foods give you more 

energy in every bite. 

Easy to prepare 

These foods were chosen because they are singleserve, easy to prepare, and can be kept at room 

temperature for up to six months. 

We want you to stay healthy once you leave the 

hospital. Enjoy these foods on us! 

In addition to these meal packages, you may also need: 

Water, bowls & plates, forks, knives & spoons, can opener, microwave, scissors 

Grant funds from the Administration for Community Living (ACL), Grant Number 90INNU0002 and the Maryland Department of Aging assisted in the development 

of this material. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACL or Department. 
Maryland Discharge Meal Program Pilot: Feedback Survey 

INFORMATION FOR SURVEY ADMINISTOR 

(NOT TO BE SHARED WITH PATIENT) 

PURPOSE/BACKGROUND: 

 The purpose of this survey is to collect feedback from clients participating in the Maryland 

Discharge Meal Program (MDMP) pilot in order to improve the program for future clients. 

 The surveys are anonymous and administered in the following order of preference: 

1) in person 

2) by telephone. If these attempts are unsuccessful, then 

3) by mail. 

 Document both successful and unsuccessful survey administration contacts on the MDMP 

tracking form. 

 Do not indicate patient’s name or any personal information on the forms. 

 The hospital MDMP coordinator will ensure proper tracking of the surveys and will fax 

groups of completed surveys by the 5th business day of each month to the Maryland 

Department of Aging FAX, to the attention of Laura Sena at 410-333-7943. 

INSTRUCTIONS FOR SURVEY ADMINISTRATION: 

STEP 1: 

Administer survey verbally face-to-face (if possible) at or around day 13 post-admission. 

Document patient’s responses on the attached form. 

STEP 2: 

If in-person administration is not possible, call the patient to administer the feedback survey 

verbally by telephone at or around day 13 post-discharge and document his/her responses on 

the attached form. If calls are unsuccessful, attempt twice more before day 30 post-discharge. 

STEP 3: 

If 3 phone call attempts do not succeed by day 30 post-discharge, send paper survey along 

with a stamped return envelope addressed to the Maryland Department of Aging with 

instructions to return within 2 weeks of receiving to: 

Laura Sena, Innovations in Nutrition Programs 

Maryland Department of Aging 

301 W. Preston Street, Suite 1007 

Baltimore, MD 21201 
Maryland Discharge Meal Program Pilot: Feedback Survey 

THIS PAGE INTENTIONALLY LEFT BLANK 
Maryland Discharge Meal Program Pilot: Feedback Survey 

This survey contains questions about the meal packages that you received from the Maryland 

Discharge Meal Program Pilot. Your answers will be kept confidential. For this set of questions, 

we would like you to think about how the meals may have helped you, compared with how you 

might have felt if you didn’t receive them. Do you feel the meal packages...

1. Helped you recover after being in the hospital? 

□ Yes 

□ No 

2. Kept you from losing weight? 

□ Yes 

□ No 

3. Helped you manage your health condition (for example, hypertension, diabetes, etc.)? 

□ Yes 

□ No 

4. Provided you with food that you wouldn’t have otherwise been able to buy or shop for?

□ Yes 

□ No 

5. Provided you with something to eat when you had difficulty preparing your own meals? 

□ Yes 

□ No 

6. Helped you eat healthier food? 

□ Yes 

□ No 

7. Considering all the meal packages combined, how much of the food did you eat? 

□ 1⁄4 or less 

□ 1⁄2 or less 

□ 3⁄4 or less 

□ Almost all 

8. Do you feel the foods met your nutritional needs based on your health condition? 

□ Yes 

□ No 

□ If yes, how? ____________________________ 

□ If no, why not? ____________________________ 

9. Of the foods you received, what were your top 3 favorites? 

1) _____________________________ 

2) _____________________________ 

3) _____________________________ 
 

Maryland Discharge Meal Program Pilot: Feedback Survey 

10. Of the foods you received, what were your 3 least favorite? 

1) _____________________________ 

2) _____________________________ 

3) _____________________________ 

11. Did you have any trouble opening the food packages? 

□ Yes 

□ No 

□ If yes, which ones? ____________________________ 

12. Was it easy to get the meal packages home from your hospital discharge and follow-up 

visit (if applicable)? 

□ Yes 

□ No 

□ If no, please describe any issues. ____________________________ 

13. Did the second meal package make it more likely for you to attend your follow-up visit? 

□ Yes 

□ No 

□ Not applicable 

14. Did you find the “What’s in Your Bag?” menus provided helpful?

□ Yes 

□ No 

□ If no, why not? ____________________________ 

15. Did the pilot program help you connect to organization(s) that provide wellness, meals, 

financial, housing, caregiver supports (or similar services)? 

□ Yes 

□ No 

□ If yes, what organization(s)? ____________________________ 

16. Did the pilot program help you connect to program(s) that can help you eat better, like 

senior centers, food pantries, SNAP, etc.? 

□ Yes 

□ No 

□ If yes, what program(s)? _______________________________ 

IF YOU RECEIVED THIS SURVEY BY MAIL, PLEASE PLACE YOUR COMPLETED 

FORM IN THE ENVELOPE PROVIDED AND MAIL BACK PROMPTLY. 

THANK YOU! WE APPRECIATE YOUR FEEDBACK! 

Date Survey Completed: _____________________________ 
Maryland Discharge Meal Program Pilot: 

Summary and Implementation Instructions 

*Note to host organization: BEFORE YOU DISTRIBUTE TO STAFF please 

fill in the underlined, highlighted sections that apply to your hospital. 

PROGRAM SUMMARY 

Background 

 Your hospital is one of four Maryland hospitals participating in the Maryland Discharge 

Meal Program Pilot. Congratulations in being part of this innovative project! 

 Each hospital will provide medically-tailored meals for 50 patients upon discharge, 

beginning in March 2019 through approximately May 2019. 

 Meals are shelf-stable and require minimal preparation (water, microwave, can opener). 

Complete nutritional support (3 meals and 2 snacks per day), except for fluid, is provided 

for 12 days post-discharge. The MDMP pilot offers two diet types. 

 The program is funded and overseen by the Maryland Department of Aging via a grant 

from the federal Administration for Community Living. 

 The Maryland Food Bank assembles the meal packages and delivers them to the hospital 

and a secondary, follow-up site for distribution 



Resources – located in Appendices. Please see detailed instructions on the following pages. 

Your Hospital Coordinator is: __________________________, in case you have 

questions. 

Resource Purpose 

A: Tracking Sheet  Required tracking information for outcome data analysis and to keep 

track of project progress 

B: Ordering 

Instructions 

 Includes information about meal package dimensions and weight and 

instructions for placing email orders to the Maryland Food Bank 

C: Provider 

Educational Materials 

 Explains the two different diet types and what is inside of each box for 

healthcare providers 

D: Patient Selection 

Flowsheet 

 Lists circumstances that would make a patient ineligible for this 

program including certain diet restrictions, living circumstances, etc. 

 Includes information to help staff ensure a good match between 

patient and meal package 

E: Consent Form  Ensures patient is aware of purpose of project and agrees to terms 

regarding privacy and liability 

F: Community 

Referral Handout 

 Provides community based referrals for long-term support services, if 

needed 

G: Patient 

Educational Materials 

 Explains the diet provided and how to use the foods to create a daily 

menu of meals 

H: Feedback Survey  Collects anonymous feedback from patients to measure if pilot is 

meeting goals and objectives and to improve the program for future 

participants 

1 
Tracking the Pilot 

 

Ordering Meal Packages (as needed, 50 patients per hospital) 

Maryland Discharge Meal Program Pilot: 

Summary and Implementation Instructions 

IMPLEMENTATION INSTRUCTIONS 

TRACKING, ORDERING, MEAL PAKCAGING AND DISTRIBUTION 

Person(s) Involved 

 Input tracking information: __________________________ 

Details: 

 The Tracking Sheet will be used to keep track of patient information for input into CRISP 

by Alice Chan at the University of Maryland St. Joseph Medical Center as well as pilot 

progress and logistics (including verification of patient’s signing the consent form and

hospital administration of feedback survey). 

 Hospital Coordinator - please ensure proper tracking and send the Tracking Sheet to 

Alice Chan via HIPAA-compliant, secure transmission methods at 

AliceChan@umm.edu by the 5th business day of each month. 

 There is space for 50 patients on the excel so please continue to add to the same Tracking 

Sheet throughout the pilot and submit as-is each month. 

 The “Referral Criteria” and “Diagnosis” sections as well as the Initial and Follow-Up 

Package “Location” and “Days of Meals” should be customized to your specific hospital.

Resource: 

 Tracking Sheet (Appendix A) 

Person(s) Involved: 

 Place orders:__________________________ 

Details: 

 Orders are to be provided via email to the Maryland Food Bank, no later than Tuesdays at 

10:30AM for deliverers on Thursdays and Fridays. There is a minimum order size of 20 

boxes. Orders will be standardized to a 50/50 split of each diet type. 

 Email subject line should read “Maryland Discharge Meal Program New Order.” Include: 

o Desired delivery date 

o Delivery location 

o Quantity of boxes 

 Please send emails to Tracey, the main contact, and cc Jessica, Zak, and Gary. 

 Email addresses: 

o Tracey Ivison (Partner Services Supervisor) – tivison@mdfoodbank.org 

o Jessica Corcelius (Partner Services Director) – jcorcelius@mdfoodbank.org 

o Zak Jeffries (Warehouse Manager) – zjeffries@mdfoodbank.org 

o Gary Melvin (Transportation Manager) – gmelvin@mdfoodbank.org 

 Phone numbers: 

o Tracey Ivison – 443-297-5080 

o Jessica Corcelius – 443-297-5193 

o Zak Jeffries – 443-297-5207 

o Gary Melvin – 443-297-5149 

Resource: 

 Ordering Instructions (Appendix B) 

2 
 

 

Maryland Discharge Meal Program Pilot: 

Summary and Implementation Instructions 

Meal Packaging 

The MDMP program offers two diet types including Carbohydrate-Controlled, Heart-Healthy 

and Enhanced Healing (high-protein, high-energy). Each diet type has an “A” and “B” 3-day 

menu for increased variety. 

Packaging Ziploc bags (3) Grocery Totes (2) Box (1) 

# of day of 

meals One day/bag Three days/tote Six days/box 

Weight 3-4 lbs 11-12 lbs 22-24 lbs 

Dimensions 15.5” x 11.5” x 11.5”

 Each Ziploc bag contains a one day supply of meals 

 3 Ziplocs are packaged into one grocery tote which will be given to patients (three day 

supply of meals) 

 Two grocery totes are packaged into a box for transportation and storage purposes (six 

day supply of meals) 

Resource: 

 Provider Educational Materials (Appendix C) 

Meal Distribution 

Initial package at discharge  Follow-up package at follow-up and/or home visit 

 Each patient will receive 4 grocery totes total (12 day supply of meals). Each hospital 

will determine how many meals patients receive upon discharge and follow-up. 

 Patients will receive 1 or 2 grocery totes (a 3 or 6 day supply of meals) at hospital 

discharge 

 Patients will receive 3 or 2 grocery totes (a 9 or 3 day supply of meals) at follow-up after 

discharge 

 Meal packages are delivered in boxes. Hospitals are responsible for removing the grocery 

totes from the boxes before distribution to patients. 

3 
Maryland Discharge Meal Program Pilot: 

Summary and Implementation Instructions 

WHAT YOU NEED TO KNOW: STEP BY STEP 

Step 1: Patient Eligibility and Diet Selection 

Person(s) Involved: 

 Refer patients: __________________________ 

 Determine eligibility and meal package type: __________________________ 

Details: 

 Each hospital has decided which patient types are referred to this program. Typically, 

referral criteria is related to high risk for re-admission, medical diagnosis (CHF, COPD, 

and/or diabetes), malnutrition, food insecurity, etc. 

 Your hospital’s specific referral criteria includes: ________________________________ 

________________________________________________________________________ 

 Referred patients then are assessed for eligibility based on whether they are appropriate 

to receive the meals, which is based on their dietary restrictions, discharge destination, 

and other criteria outlined in the Patient Selection Flowsheet. 

 Eligible patients then need to be matched to one of the two diet types. This criteria is also 

outlined in the Patient Selection Flowsheet. If you have any questions, please contact 

your inpatient dietitian, as appropriate. 

Resource: 

 Patient Selection Flowsheet (Appendix D) 

Step 2: Obtain Patient Consent 

Person(s) Involved: 

 Administer consent form:__________________________ 

Details: 

 Execution of the consent form is required for participation in the pilot program. Hospital 

staff should administer the consent form to the patient and forms should be retained by 

the Hospital Coordinator. They should not be sent to the Maryland Department of Aging. 

Resource: 

 Consent Form (Appendix E) 

Step 3: Distribute Initial Meal Package 

Person(s) Involved: 

 Coordinate distribution at discharge: __________________________ 

Details: 

 The first meal package will be provided at hospital discharge. 

 The patient will receive 1 or 2 grocery totes (a 3 or 6 day supply of meals). 

 Patient educational materials will be pre-packaged within the meal package for the 

patient. These materials will explain the diet provided and how to use the foods to create 

a daily menu of meals. There will also be a handout with community-based referrals for 

long-term support services, if needed, including SNAP, Area Agencies on Aging, food 

pantries, and United Way 211. 

Resources: 

 Community Referral Handout (Appendix F) 

 Patient Educational Materials (Appendix G) 

4 
Maryland Discharge Meal Program Pilot: 

Summary and Implementation Instructions 

Step 4: Distribute Follow-Up Meal Package 

Person(s) Involved: 

 Coordinate distribution at follow-up: __________________________ 

Details: 

 The second meal package will be picked up by the patient at a follow-up visit and/or 

delivered during a home visit. The goal is to provide an incentive for the patient to attend 

their follow-up visit or comply with a home visit. 

 The patient will receive the remaining 3 or 2 grocery totes (a 9 or 6 day supply of meals). 

 This is an important time to discuss the Community Referral Handout with the patient. 

We encourage you to connect with your local Area Agency on Aging to identify needed 

services and programs. Also, Maryland Food Bank and local food pantry information is 

provided to address food insecurity issues. 

Resource: 

 Community Referral Handout (Appendix F) 

 Patient Educational Materials (Appendix G) 

Step 5: Administer Feedback Survey 

Person(s) Involved: 

 Administer feedback survey:__________________________ 

Details: 

 An anonymous feedback survey will be administered in the following order of preference 

by the hospital: 

1) in person at or around day 13 post-admission 

2) by telephone if in-person administration is not possible; at or around day 13-

post discharge; if unsuccessful, attempt twice more before day 30 post-discharge 

3) by mail if phone call attempts do not succeed by day 30 post-discharge; send 

paper survey along with a stamped return envelope addressed to the Maryland 

Department of Aging with instructions to return within 2 weeks of receiving to: 

Laura Sena, Innovations in Nutrition Programs 

Maryland Department of Aging 

301 W. Preston Street, Suite 1007 

Baltimore, MD 21201 

 As you administer the survey in-person or by phone, please complete the survey 

instrument 

 The survey administrator should document both successful and unsuccessful attempts to 

contact the patient on the Tracking Sheet 

 Hospital Coordinator - please ensure surveys contain no patient information and fax 

groups of completed surveys to the Maryland Department of Aging, to the attention 

of Laura Sena at 410-333-7943 by the 5th business day of each month. 

Resource: 

 Feedback Survey (Appendix H) 

5 
Maryland Discharge Meal Program Pilot: 

Summary and Implementation Instructions 

Appendix 

A. Tracking Sheet 

B. Ordering Instructions 

C. Provider Educational Materials 

D. Patient Selection Flowsheet 

E. Consent Form 

F. Community Referral Handout 

G. Patient Educational Materials 

H. Feedback Survey 

6 
Appendix A: Tracking Sheet 

MDMP TRACKING SHEET *Send this form via HIPAA compliant manner to Alice Chan at AliceChan@umm.edu by the 5th business day of each month 

*Fill out these sections as they pertain to your hospital.

Days of meals Date Days of meals Date

 Specific diagnosis

Food insecurity  Malnutrition

 T2DM

CHFCOPD

 CC/HH

Enhanced Healing

 Home Visit

Care ClinicAAA

In PersonPhoneMail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

CC/HH In PersonEnhanced Healing Phone

Mail

Feedback Survey 

AdministrationN/A

9/29 10/8 10/16

10/16

8

9

10

1112

Patient 

#

0

12

34

56

7

Patient Signed 

Consent

9/16/18

Follow-Up Meal Package

9/19/18 9

Location

Diet Type (only 

choose ONE) Location

Referred By Referral Criteria Met List 

Diagnosis

Initial Meal Package

3 9/16/18 Hospital 

Discharge 1234567

Discharge 

Date

Medical 

Record 

Number

Aetna Template

Insurance 

Provider

Sally Jones, 

Case Manager Example

Admission 

Date

9/10/18 9/16/18

Patient 

Last Name

Patient 

First Name

7 
Package sizes: Outer package dimension – 15.5”x 11.5”x 11.5”

Weight per box – 22-24 lbs. for 6 days box 

Weight per bag – 11-12 lbs for each cloth grocery bag 

 Note: Enhanced Healing package will be slightly heavier than Carb-Controlled/Heart-Healthy 

 

 

 

 

Appendix B: Ordering Instructions 

MARYLAND DISCHARGE MEAL PROGRAM PILOT: ORDERING INSTRUCTIONS 

Order processing for the pilot follows: 

Deliveries will occur on Thursdays and Fridays, so please place orders no later than Tuesdays at 

10:30AM. 

Delivery windows: either 8-12PM or 12-4PM 

Minimum order size: 20 boxes 

Note: Orders will be standardized to a 50/50 split of each of the 2 diet types (1⁄2 Carb-Controlled/HeartHealthy and 1⁄2 Enhanced Healing) 

Please send email orders to Tracey, the main contact, and cc Jessica, Zak, and Gary. 

Email address: Tracey Ivison (Partner Services Supervisor) - tivison@mdfoodbank.org 

Jessica Corcelius (Partner Services Director) – jcorcelius@mdfoodbank.org 

Zak Jeffries (Warehouse Manager) - zjeffries@mdfoodbank.org 

Gary Melvin (Transportation Manager) – gmelvin@mdfoodbank.org 

Email is the best and most effective way to contact the team however phones are: 

Tracey Ivison – 443.297.5180 

Jessica Corcelius 443.297.5193 

Zak Jeffries - 443.297.5207 

Gary Melvin – 443.297.5149 

Email instructions: 

Email subject line: Maryland Discharge Meal Program New Order 

Email should include: 

 Desired delivery date 

 Delivery location 

 Quantity of boxes 

8 
Appendix C: Provider Educational Materials 

9 

What’s In Your Box?

Boxes either contain:

Carb-Controlled, Heart-Healthy meal plan or Enhanced Healing Meal Plan.

Each patient only gets one type of meal plan.

Use the Patient Selection Flowsheet to help you determine which meal plan is right for your patient. 

Provide tote bags to the patients. Each patient gets four bags total (12 days of food) – an initial set of bags 

at discharge and the remainder at follow-up.

Tote Bag A: Points to meal plans for day 1, 2, and 3. 

Tote Bag B: Points to meal plans for day 4, 5, and 6.
Your patient will either get a Carb-Controlled, HeartHealthy or a Enhanced Healing meal package plan. 

Here are the differences between the two: 

Carb-Controlled, Heart-Healthy 

• Calorie range 1500 -1700 per day

• Carbohydrates are 45-55% of total

calories in accordance with the

adult Dietary Reference Intake*

• Carbohydrates are spread evenly 

between meals. • Meals are about 3-4 carb choices each

and snacks are 1-2 carb choices.

• Moderate total fat {25 -33% of

total calories)

• Adequate protein for maintaining

muscle {18 -20% of total calories)

• Sodium is under 2,000 mg per day

Enhanced Healing 

(high energy & high protein) 

• Higher calories for medical

conditions that use more energy

(1900-2500 Calories per day)

• Adequate protein for maintaining

muscle (over 100 grams per day)

• No restrictions on fat,

carbohydrates, or sodium

Additional information for both meal package plans: 

• Easy to prepare. Requires: • Spreading with a knife • Opening a can • Pulling off a cap • Mixing • Puncturing with a straw • Pulling open a package • Additional kitchen items required: • Water • Bowls & plates • Forks, knives & spoons • Can opener • Microwave • Optional: scissors (if patient has 

difficulty opening packages) 

Grantfundsfrom the Adm inistration for Community Uving(ACL) and the Maryland Department of Agingassiste d in 

the developmentof thismaterial. Points of view or opinions contained herein are those of the author5and do not 

necessar ily represent the offic ial position or policies of the ACL or Department 

*SOURCE: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids {2002/2005). 

https://www.ncbi.nlm.nih.gov/books/NBK56068/table/summarytables.t5/?report=objectonly 

10 
Start Is My Patient Eligible? 

Does your patient have any of the following orders at time of discharge? 

- A sodium restriction of less than 2000mg per day? 

A fluid restriction of less than 1500mL per day? 

A potassium, phosphorous or protein restriction 

A modified texture diet order 

-

-

-

No to all Yes to any 

Your patient is not eligible for meal packages.* 

Is any of the following true about your patient at time of discharge? 

-

-

-

Patient is being discharged to a facility that provides more than seven (7) 

meals per week (assisted living facility, skilled nursing facility, etc.) 

Patient has a diagnosed food allergy 

Patient has Celiac Disease 

No to all Yes to any 

Your patient is not eligible for meal packages.*

 Is any of the following true about your patient at time of discharge? 

-

-

Patient has no access to refrigeration or storage space (i.e. patient does not 

have a place of residence) 

Patient has an active substance addiction (including alcohol) and is not 

currently in active treatment 

No to all Yes to any 

Your patient is not eligible for meal packages. 

Please see the Community Referral Handout for 

more options. 

Is your patient older than 50? 

Yes No 

Your patient is not eligible for meal packages. 

Please see the Community Referral Handout for 

more options. 

* Please contact your inpatient dietitian for further evaluation if you have any questions or if you are unsure of patient eligibility. 

Provide this flowsheet to the dietitian and nutritional information for meal packages found on the back. 

Which Meal Package Plan? 

Patient has higher nutritional needs based on 

medical condition. This includes: 

-

-

-

COPD diagnosis 

Positive malnutrition risk screen or malnutrition 

diagnosis 

Order for dietary supplements 

Patient has need for diabetes diet and/or 

heart-healthy diet OR has no dietary restrictions 

(regular diet order) 

Provide patient with the 

Enhanced Healing

Meal Package 

Provide patient with the 

Carb-Controlled, Heart-Healthy 

Meal Package 

Appendix D: Patient Selection Flowsheet

11
Lunch rinneD nacksS 1 saltTo

tsfakaerB

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Corn Flakes, Fruit Cup, Granola Bar, Milk 

Oatmeal, Craisins, Granola Bar, Milk 

Cereal, Craisins, Granola Bar, Milk Corn Flakes, Fruit Cup, Granola 

Bar, Milk 

Cereal, Fruit Cup, Granola Bar, Milk 

Oatmeal, Raisins, Granola Bar, Milk 

unchL

Tuna, Crackers, Tomato Soup, Mayo Packet 

Rice & Quinoa, Corn Cup, Salsa, 

Protein Bar 

Tuna, Corn Cup, Vegetable Soup, 

Crackers, Peanut Butter 

Chicken, Crackers, Chicken Noodle Soup 

Tuna, Crackers, Tomato Soup, Peanut butter 

Rice & Quinoa, Corn Cup, Vegetable Soup, Yogurt 

rneniD Pasta, Chicken, Green Bean Cup, Yogurt Chicken, Raisins, Crackers, Mayo Packet, Carrot Cup, Chocolate Milk Salmon, Mac & Cheese, Green Bean Cup Rice & Quinoa, Tuna, Green Bean Cup, Mayo Packet, Yogurt Chicken, Mac & Cheese, Carrot Cup Salmon, Pasta, Carrot Cup, Mayo Packet sacknS Pretzels, Peanut Butter, Chocolate Milk, Ensure, Protein Bar Pretzels, Peanut Butter, Ensure, Applesauce, Yogurt Fruit Cup, Yogurt, Protein Bar, Fruit Snacks, Ensure Applesauce, Ensure, Chocolate Milk, Protein Bar Fruit Snacks, Yogurt, Ensure, Applesauce, Protein Bar Fruit Cup, Ensure, Protein Bar, Crackers, Peanut Butter 

1 salotT Kcal Pro Fat CHO Na+ K+ 2430 123 75 334 2850 2789 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 

2360 99 76 322 2740 2895 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 2018 110 65 265 2565 2507 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1970 105 58 274 2270 2684 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 2018 106 67 266 2365 2499 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 2430 105 77 334 2465 2750 

g g g mg mg 

Carb-Controlled, Heart-Healthy 

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 

tsfaakerB Corn Flakes, Fruit Cup, Granola Bar, Milk 68g of Carbs Oatmeal, Granola Bar, Milk 46g of Carbs Cereal, Craisins, Milk 64g of Carbs Corn Flakes, Fruit Cup, Granola Bar, Milk 68g of Carbs Cereal, Fruit Cup, Milk 58g of Carbs Oatmeal, Granola Bar, Milk 46g of Carbs 

Crackers, Tuna, Tomato Soup, 

Mayo Packet 

45g of Carbs 

Pasta, Chicken, Green Bean Cup, Yogurt 

60g of Carbs 

Crackers, Peanut Butter 

33g of Carbs 

Rice & Quinoa, Corn Cup, Salsa, Protein Bar 

68g of Carbs 

Raisins, Chicken, Carrot Cup, Mayo 

Packet, Crackers 

48g of Carbs 

Fruit Snacks, Yogurt, Applesauce 

54g of Carbs 

Tuna, Corn Cup, Vegetable Soup, Crackers, Peanut Butter 

53g of Carbs 

Salmon, Pasta, Green Bean Cup, Mayo Packet 

45g of Carbs 

Fruit Cup, Yogurt, Granola Bar 

46g of Carbs 

Chicken, Crackers, Chicken Noodle Soup, Carrot Cup, Craisins 

57g of Carbs 

Pasta, Tuna, Green Bean Cup, 

Mayo Packet 

44g of Carbs 

Yogurt, Applesauce, Raisins 

57g of Carbs 

Crackers, Tuna, Tomato Soup, Peanut Butter 

56g of Carbs 

Chicken, Raisins, Crackers, Mayo Packet, Carrot Cup 

48g of Carbs 

Applesauce, Yogurt, Granola Bar 

49g of Carbs 

Rice & Quinoa, Vegetable Soup 

57g of Carbs 

Salmon, Pasta, Green Bean Cup, Mayo Packet 

45g of Carbs 

Yogurt, Fruit Snacks, Protein Bar 

51g of Carbs 

Kcal Pro Fat CHO Na+ K+ 1630 76 62 206 2035 1875 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1560 70 47 216 1850 1779 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1598 79 57 208 1890 2018 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1480 68 39 226 1855 1743 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1598 71 60 211 1685 2269 

g g g mg mg 

Kcal Pro Fat CHO Na+ K+ 1520 78 44 199 1545 1486 

g g g mg mg 

Enhanced Healing (high-protein, high-energy) 

1Nutrition facts are estimates based on most accurate data and may not reflect the exact nutritional makeup of the meal packages. Days 1-3 and Days 4-6 are packaged together and a client may not eat everything in 

the exact order as described on this page. 
 

 

 

 

 

 

 

 

 

 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

Appendix E: Maryland Discharge Meal Program Pilot: Acknowledgement & Authorization 

Purpose & Background 

The first two weeks following a discharge from a hospital are very important for recovery. Many patients are at 

high risk for poor nutrition and readmission to the hospital during this time. The Maryland Discharge Meal Pilot 

Program is intended to help smooth the transition from hospital to home and to improve the nutritional status of 

the patients selected by the participating hospital for the pilot. 

The Program includes 12 days of medically tailored, shelf-stable food paid for by the Maryland Department of 

Aging via a grant from the federal Administration for Community Living. The Maryland Food Bank assembles 

the food packs for the Program. The initial pack of food will be provided by the hospital upon discharge and the 

second pack of additional food will be available for pickup at a follow-up visit or delivered during a home visit. 

Participating individuals will be asked to reply to an anonymous client feedback survey. 

Not all patients are medically eligible for this meal program. Eligibility criteria is included in the Patient 

Selection Flowsheet. 

I understand, acknowledge, and agree that: 

1. I am receiving the initial food pack from the hospital discharging me, 

2. I will pick up (or if the hospital so provides, receive) the second pack, 

3. My discharging hospital has discussed this pilot program with me in detail and explained to me where I 

have to go and what I have to do to pick up the second pack, 

4. I have discussed the eligibility criteria and have disclosed any relevant information to the hospital, 

5. This program does not deal with emergency situations and if I need immediate help, I will call 911, 

6. This is a voluntary program, 

7. At any time, I have the right to revoke my consent to the release of information I have provided below, 

and that, in any event, my consent will expire one year from the date I sign this acknowledgement, and 

8. There is no cost to participate, but the food provided is for my consumption alone and must not be given 

or sold to others. 

Client Authorization for Release of Information 

I consent to: 

1. The hospital contacting me in person, by telephone, or by mail for a follow up feedback survey, 

2. The hospital sending the results of the survey in an anonymous* fashion so that my identity is not 

disclosed, to the Maryland Department of Aging, 

3. My discharging hospital sharing certain anonymous* information with the Maryland Department of Aging 

so the Department can know what food packs have been provided by hospitals and been picked up by 

participants, and 

4. My discharging hospital sharing certain health information developed by the hospital with the University 

of Maryland St. Joseph Medical Center so the effectiveness of the pilot can be evaluated. 

*Anonymous means no personally identifying information, such as name or address, is reported and all data is 

reported in a summary format so no individual can be identified. 

I have read this and understand it. If there were parts I did not understand, I asked questions and had it explained 

to me. 

Name of Patient (Printed) 

Signature of Patient Date 

Name of Discharging Hospital 

13 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you need food or other support.... 

These 

resources 

may help! 

Have you applied for SNAP? 

 “SNAP” stands for “Supplemental Nutrition Assistance

Program” - formerly known as food stamps. SNAP is a

government program. You can apply directly to the

state or get help with your application. The Maryland

State Information/ Hotline Number is 1-800-332-6347.

 Maryland Food Bank has a SNAP Outreach Team that

can help with your application. Phone toll-free 1-888-

808-7327, Monday-Friday 8am to 5pm.

Area Agencies on Aging provide a wide array of services to 

people 60 or older, including hot or cold home-delivered meals 

and group dining (senior center meals). To get connected with 

your local Area Agency on Aging, call the Maryland Department 

of Aging at 410-767-1100. 

Maryland Acccess Point (MAP) is a onestop source of information and assistance for 

long term services and supports. These include...

• Information on health

• Transportation

• Income and financial aid

• Senior and community centers and clubs

• Nutrition and meals

• Pharmacy assistance

• Housing

• Volunteer opportunities

• And more!

Get connected by calling 1-844-627-5465 or go 

to www.MarylandAccessPoint.info 

Grant funds from the Administration for Community Living (ACL) and the Maryland Department 

of Aging assisted in the development in this material. Points of view or opinions contained 

herein are those of the authors and do not necessarily represented the official position or 

policies of the ACL or Department. 

Appendix F: Community Referral Handout 

14
These 

resources 

may help!

If you need food or other support....

Food Pantries want to help. 

To find a food pantry in your area: 

1. Go to the Maryland Food Bank website https://mdfoodbank.org

2. Click on the words “Find Food” in the top right-hand corner.

3. Scroll down, then click inside the grey box below the words “Address or Zip Code”

4. Enter your address or zip code, select the “within” miles and click on “Submit”

These 

resources 

may help! 

Other services can help by easing emotional or 

financial burdens in other parts of your life. 

The United Way has a free, confidential information and 

referral service. 

To get help, call 2-1-1, 24 hours a day, 7 days a 

week. 

If you can’t reach them by calling 2-1-1, use 

these numbers: 

• Greater Baltimore: 410-685-0525

Elsewhere in Maryland 1-800-492-

0618 

TTY (for hearing impaired) 410-685-

2159 (weekdays 8:30am-4:45pm). 

You can also go to the website 

www.211md.org 

•

•

•

15
Day 1 

Day 2 

Nutritional Content Day 3 

Breakfast 

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch 

Tuna, Classic Tomato Soup, Wheat Crackers, 

Mayonnaise To-Go 

Dinner 

Barilla Pasta (1/2 bag), Premium Chicken (1/2 

can), Green Beans, Blended Yogurt 

Snacks 

Wheat Crackers, Natural Peanut Butter 

What’s in your

Bag? 

Carbohydrates 

190 – 220 grams per day 

45 – 70 grams per meal 

15 – 25 grams per snack 

Sodium 

1500 – 2000 mg/day 

Breakfast 

Quaker Oatmeal, PB & Dark Chocolate Granola Bar, 

Lowfat Milk 

Lunch 

Brown Rice & Quinoa, Sweet Corn, Picante Sauce, 

Chocolate Deluxe Protein Bar 

Dinner 

Premium Chicken (1/2 can), Raisins, Diced Carrots, 

Mayonnaise To-Go, Wheat Crackers 

Snacks 

Fruit Snacks, Blended Yogurt, Applesauce 

Breakfast 

Mini Wheats, Craisins, Lowfat Milk 

Lunch 

Tuna, Sweet Corn, Hearty Vegetable Soup, Wheat 

Crackers, Natural Peanut Butter 

Dinner 

Pink Salmon, Barilla Pasta (1/2 bag), Green Beans, 

Mayonnaise To-Go 

Snacks 

Mixed Fruit Cup, Blended Yogurt, PB & Dark 

Chocolate Granola Bar 

A Carb-Controlled, Heart-Healthy Meal Packages 16
Day 1 

Day 2 

Nutritional Content Day 3 

Breakfast 

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch 

Premium Chicken (1/2 can), Wheat Crackers, 

Hearty Chicken Noodle Soup, Diced Carrots, Craisins 

Dinner 

Barilla Pasta (1/2 bag), Tuna, Green Beans, 

Mayonnaise To-Go 

Snacks 

Blended Yogurt, Applesauce, Raisins 

What’s in your 

Bag? 

Carbohydrates 

190 – 220 grams per day 

45 – 70 grams per meal 

15 – 25 grams per snack 

Sodium 

1500 – 2000 mg/day 

Breakfast 

Mini Wheats, Mixed Fruit Cup, Lowfat Milk 

Lunch 

Tuna, Classic Tomato Soup, Wheat Crackers, 

Natural Peanut Butter 

Dinner 

Premium Chicken (1/2 can), Wheat Crackers, 

Raisins, Mayonnaise To-Go, Diced Carrots 

Snacks 

Applesauce, Blended Yogurt, PB & Dark Chocolate 

Granola Bar 

Breakfast 

Quaker Oatmeal, PB & Dark Chocolate Granola Bar, 

Lowfat Milk 

Lunch 

Brown Rice & Quinoa, Hearty Vegetable Soup 

Dinner 

Pink Salmon, Barilla Pasta (1/2 bag), Green Beans, 

Mayonnaise To-Go 

Snacks 

Blended Yogurt, Fruit Snacks, Chocolate Deluxe 

Protein Bar 

B Carb-Controlled, Heart-Healthy Meal Packages 17
Carb-Controlled, Heart-Healthy 

Meal Packages 

The Carb-Controlled, Heart Healthy meal package is designed to 

provide you with the food you need to help you recover after your 

visit to the hospital. 

Balanced carbohydrates 

Carbohydrates (carbs) from the food you eat effect 

your blood sugar. These meals and snacks are 

balanced with the right amount of carbs to keep 

your blood sugar under control throughout the 

day. 

Pro Tip 

Be sure not to add any salt to 

these foods. Try other 

seasonings, like garlic powder, 

dried herbs, Mrs. Dash SaltFree seasoning, or other saltfree seasonings. 

Low salt 

Getting too much sodium 

(salt) can raise your blood 

pressure and be bad for your 

heart health. These meals 

are low in salt to keep your 

heart healthy and your blood 

pressure under control. 

Easy to prepare 

These foods were chosen because they are singleserve, easy to prepare, and can be kept at room 

temperature for up to six months. 

We want you to stay healthy once you leave the 

hospital. Enjoy these foods on us! 

In addition to these meal packages, you may also need: 

Water, bowls & plates, forks, knives & spoons, can opener, microwave, scissors 

Grant funds from the Administration for Community Living (ACL), Grant Number 90INNU0002 and the Maryland Department of Aging assisted in the development 

of this material. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACL or Department. 

18
Day 2 

Breakfast

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Wheat Crackers, Tuna, Classic Tomato Soup, 

Mayonnaise To-Go 

Dinner

Barilla Pasta, Premium Chicken (1/2 can), Green 

Beans, Blended Yogurt 

Snacks

Pretzels, Natural Peanut Butter, Chocolate Milk, 

Ensure Shake, Deluxe Chocolate Protein Bar 

What’s in your 

Bag? 

Breakfast

Quaker Oatmeal, Craisins, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Brown Rice & Quinoa, Sweet Corn, Picante Sauce, 

Deluxe Chocolate Protein Bar 

Dinner

Wheat Crackers, Premium Chicken (1/2 can), 

Raisins, Diced Carrots, Mayonnaise To-Go, 

Chocolate Milk 

Snacks

Pretzels, Natural Peanut Butter, Ensure Shake, 

Applesauce, Blended Yogurt 

Breakfast

Mini Wheats, Craisins, PB & Dark Chocolate Granola 

Bar, Lowfat Milk 

Lunch

Tuna, Sweet Corn, Hearty Vegetable Soup, Wheat 

Crackers, Natural Peanut Butter 

Dinner

Pink Salmon, Mac & Cheese, Green Beans 

Snacks

Mixed Fruit Cup, Blended Yogurt, Deluxe Chocolate 

Protein Bar, Fruit Snacks, Ensure Shake 

Day 1 

Day 3 

A Enhanced Healing Meal Packages 

19
Day 2 

Breakfast

Corn Flakes, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Premium Chicken (1/2 can), Wheat Crackers, 

Hearty Chicken Noodle Soup 

Dinner

Brown Rice & Quinoa, Tuna, Green Beans, Blended 

Yogurt, Mayonnaise To-Go 

Snacks

Ensure Shake, Applesauce, Deluxe Chocolate Protein 

Bar, Chocolate Milk 

What’s in your 

Bag? 

Breakfast

Mini Wheats, Mixed Fruit Cup, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Tuna, Classic Tomato Soup, Wheat Crackers, 

Natural Peanut Butter 

Dinner

Premium Chicken (1/2 can), Mac & Cheese, Diced 

Carrots 

Snacks

Fruit Snacks, Blended Yogurt, Deluxe Chocolate 

Protein Bar, Applesauce, Ensure Shake 

Breakfast

Quaker Oatmeal, Raisins, PB & Dark Chocolate 

Granola Bar, Lowfat Milk 

Lunch

Brown Rice & Quinoa, Sweet Corn, Hearty Vegetable 

Soup, Blended Yogurt 

Dinner

Pink Salmon, Barilla Pasta, Diced Carrots, 

Mayonnaise To-Go 

Snacks

Mixed Fruit Cup, Ensure Shake , Deluxe Chocolate 

Protein Bar, Wheat Crackers, Natural Peanut Butter 

Day 1 

Day 3 

B Enhanced Healing Meal Packages 20
Enhanced Healing 

Meal Packages 

The Enhanced Healing meal package is designed to provide you 

with the food you need to help you recover and stay strong after 

your visit to the hospital. 

High protein 

Protein helps keep your immune system strong, 

keep you from losing muscle, and helps wounds to 

heal. These foods give you enough protein to keep 

your muscles strong and to help you heal and 

recover after your hospital stay. 

High energy 

Eating a balanced diet and getting enough energy 

from your food is very important when you’re 

recovering. It can be hard to get enough to eat 

when you are sick, so these foods give you more 

energy in every bite. 

Easy to prepare 

These foods were chosen because they are singleserve, easy to prepare, and can be kept at room 

temperature for up to six months. 

We want you to stay healthy once you leave the 

hospital. Enjoy these foods on us! 

In addition to these meal packages, you may also need: 

Water, bowls & plates, forks, knives & spoons, can opener, microwave, scissors 

Grant funds from the Administration for Community Living (ACL), Grant Number 90INNU0002 and the Maryland Department of Aging assisted in the development 

of this material. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACL or Department. 

21
PURPOSE/BACKGROUND: 

Appendix H: Maryland Discharge Meal Program Pilot: Feedback Survey 

INFORMATION FOR SURVEY ADMINISTOR 

(NOT TO BE SHARED WITH PATIENT) 

 The purpose of this survey is to collect feedback from clients participating in the Maryland

Discharge Meal Program (MDMP) pilot in order to improve the program for future clients.

 The surveys are anonymous and administered in the following order of preference:

1) in person

2) by telephone. If these attempts are unsuccessful, then

3) by mail.

 Document both successful and unsuccessful survey administration contacts on the MDMP

tracking form.

 Do not indicate patient’s name or any personal information on the forms.

 The hospital MDMP coordinator will ensure proper tracking of the surveys and will fax

groups of completed surveys by the 5th business day of each month to the Maryland

Department of Aging FAX, to the attention of Laura Sena at 410-333-7943.

INSTRUCTIONS FOR SURVEY ADMINISTRATION: 

STEP 1: 

Administer survey verbally face-to-face (if possible) at or around day 13 post-admission. 

Document patient’s responses on the attached form. 

STEP 2: 

If in-person administration is not possible, call the patient to administer the feedback survey 

verbally by telephone at or around day 13 post-discharge and document his/her responses on 

the attached form. If calls are unsuccessful, attempt twice more before day 30 post-discharge. 

STEP 3: 

If 3 phone call attempts do not succeed by day 30 post-discharge, send paper survey along 

with a stamped return envelope addressed to the Maryland Department of Aging with 

instructions to return within 2 weeks of receiving to: 

Laura Sena, Innovations in Nutrition Programs 

Maryland Department of Aging 

301 W. Preston Street, Suite 1007 

Baltimore, MD 21201 

22 
Appendix H: Maryland Discharge Meal Program Pilot: Feedback Survey 

THIS PAGE INTENTIONALLY LEFT BLANK 

23 
 

Appendix H: Maryland Discharge Meal Program Pilot: Feedback Survey 

This survey contains questions about the meal packages that you received from the Maryland 

Discharge Meal Program Pilot. Your answers will be kept confidential. For this set of questions, 

we would like you to think about how the meals may have helped you, compared with how you 

might have felt if you didn’t receive them. Do you feel the meal packages...

1. Helped you recover after being in the hospital? 

□ Yes 

□ No 

2. Kept you from losing weight? 

□ Yes 

□ No 

3. Helped you manage your health condition (for example, hypertension, diabetes, etc.)? 

□ Yes 

□ No 

4. Provided you with food that you wouldn’t have otherwise been able to buy or shop for?

□ Yes 

□ No 

5. Provided you with something to eat when you had difficulty preparing your own meals? 

□ Yes 

□ No 

6. Helped you eat healthier food? 

□ Yes 

□ No 

7. Considering all the meal packages combined, how much of the food did you eat? 

□ 1⁄4 or less 

□ 1⁄2 or less 

□ 3⁄4 or less 

□ Almost all 

8. Do you feel the foods met your nutritional needs based on your health condition? 

□ Yes 

□ No 

□ If yes, how? ____________________________ 

□ If no, why not? ____________________________ 

9. Of the foods you received, what were your top 3 favorites? 

1) _____________________________ 

2) _____________________________ 

3) _____________________________ 

24 
 

Appendix H: Maryland Discharge Meal Program Pilot: Feedback Survey 

10. Of the foods you received, what were your 3 least favorite? 

1) _____________________________ 

2) _____________________________ 

3) _____________________________ 

11. Did you have any trouble opening the food packages? 

□ Yes 

□ No 

□ If yes, which ones? ____________________________ 

12. Was it easy to get the meal packages home from your hospital discharge and follow-up 

visit (if applicable)? 

□ Yes 

□ No 

□ If no, please describe any issues. ____________________________ 

13. Did the second meal package make it more likely for you to attend your follow-up visit? 

□ Yes 

□ No 

□ Not applicable 

14. Did you find the “What’s in Your Bag?” menus provided helpful?

□ Yes 

□ No 

□ If no, why not? ____________________________ 

15. Did the pilot program help you connect to organization(s) that provide wellness, meals, 

financial, housing, caregiver supports (or similar services)? 

□ Yes 

□ No 

□ If yes, what organization(s)? ____________________________ 

16. Did the pilot program help you connect to program(s) that can help you eat better, like 

senior centers, food pantries, SNAP, etc.? 

□ Yes 

□ No 

□ If yes, what program(s)? _______________________________ 

IF YOU RECEIVED THIS SURVEY BY MAIL, PLEASE PLACE YOUR COMPLETED 

FORM IN THE ENVELOPE PROVIDED AND MAIL BACK PROMPTLY. 

THANK YOU! WE APPRECIATE YOUR FEEDBACK! 

Date Survey Completed: _____________________________ 

25