This government document is issued by Department of Aging for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:p5rt2izphxk&q=https://www.aging.pa.gov/publications/aging-program-directives/Documents/Electronic%2520ENP%2520Meal%2520Service%2520Monitoring%2520Form.pdf&sa=U&ved=2ahUKEwjViKvX6K_8AhVniP0HHfU7BMQ4FBAWegQIABAB&usg=AOvVaw1u5EI8WeMMTylVTbCRxeum