This form has been meticulously crafted for registered dietitians working in long-term care facilities, aiming to enhance the nutrition assessment and interview process by ensuring the comprehensive collection of all necessary information.

It includes critical elements essential for evaluating the nutritional status of residents, such as:

  • allergies,
  • diet orders,
  • weight history,
  • diagnoses,
  • lab results,
  • medications,
  • and other pertinent factors.

For patients receiving enteral nutrition, the form includes sections dedicated to tube feed regimens, supplement content, medications, and other vital information needed to evaluate and manage enteral nutrition support effectively.

Furthermore, the form’s comprehensive design allows it to be universally applicable across various healthcare settings, including acute care, intensive care units (ICU), pediatrics, and more. This versatility ensures that dietitians can effectively assess and address the nutritional needs of patients in diverse medical environments, providing a standardized approach to nutrition care regardless of the setting.

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