Assignments no 2

Postgraduate Lifestyle Medicine certificate course

ST
1 Contact Session

Name:
SAP ID:
Assignment No:
Submission Date:
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):
Assignment no. 2

Prevailing Lifestyle Risk Factors For Disease During Patient

Observation Sessions
Output requirement:
Patient observation during online consultation with Dr. Shagufta Feroz
Data entry of minimally 10 patients on the following parameters.
Data entry can be done on given form.
All forms are required to be submitted on Moellim in word format (pdf/scan)
*Please Note: During consultation Dr. Shagufta Feroz will communicate with the patient and
you are supposed to quietly observe the discussion and note down the relevant information in
the following format. You can directly add information on the form OR take notes and fill later.

Last Date of submission is : 31st August 2023

Serial No:
Patient presentation (Disease/ Condition/ Sign and Symptoms):

(Not more than 20 words)

Early Breakfast (before 9 am): a. Yes
b. No
Type of breakfast: a. Traditional breakfast (roti, paratha)
b. Processed Food based breakfast

a. Before
Tea consumption in relation to meals: b. During
c. After
Composition of tea in relation to its a. Black
composition b. Brown
c. White (Doodh Pati)
a. no lunch
Type of Lunch: b. heavy lunch
c. light lunch
Timings of Dinner: a. Before 9:00 Pm
b. After 9:00 Pm
Water intake: a. Before Meals
b. With Meals
 c. Right After Meals
Water intake(Number of glasses): a. 4-6
b. 6-10
c. 10-15
d. More Then 15
Consumption of Desserts/fruits: a. Before Meal
b. Right After The Meal
Frequency of Junk food /fizzy drinks: a. 1-2 times a week
b. 2-4 times a week
c. 4-7 times a week
Practice of Mindful eating: (No use of c. Yes
screen, TV, Newspaper during meal d. No
consumption):
Exercise performance: a. Yes
b. No
Sleep status: a. Satisfying
b. Not satisfying
Smoking: a. Yes
b. No
If yes then how many cigarettes a day
Alcohol intake a. Yes
b. No
If yes, what is the frequency of alcohol
intake (amount and days in a week)
Addiction to drugs a. Yes
b. No
Screen Addiction a. Yes
b. No
Food/Drink addiction a. Yes
b. No
Daily Stress coping status: a. Well managed
b. Poorly managed

Are you satisfied with your following

relationships:
Personal: a. Yes
b. No
Within Family: a. Yes
b. No
Professional: a. Yes
b. No
Closing statement about patient (2-3 lines):