A Nutrition assessment form that can be used in long-term care, geriatrics, and clinical.  There is a mini-nutrition assessment portion that includes questions relating to:

  • food intake
  • weight loss
  • mobility
  • psychological stress
  • neurosurgical stress

There is also a section to guide your Nutrition Focused Physical Exam.   This form can help guide your questions and make sure you do not miss any piece of evidence.  This form guides you through the NFPE and is easy to fill out when with a patient or resident.  It can be used in long-term care of a clinical setting. You can then use it back up evidence to diagnose malnutrition or to guide a PES statement.

Lastly, the form also includes a section for food preferences while interviewing a new resident or patient.  Includes space to fill out, along with guided options to circle preferences.

 

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