Get Nutritional Assessment And Risk Level Form

Filling out the nutritional assessment and risk level form accurately is essential for determining a person's nutritional risk and needs. This guide provides clear steps to help users complete the form effectively in an online format.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the ‘Date Admitted’ section by entering the date when the individual was admitted for assessment.
3. Next, fill in the ‘Room / Bed No.’ and ‘File No.’ fields to identify the individual’s location and documentation.
4. Enter the patient’s name using the format Last, First, Middle Name in the designated field.
5. Indicate the patient’s age accurately in the field provided.
6. Fill in the height in meters (m) using decimal notation as needed.
7. Document the patient’s weight in kilograms (kg) accurately.
8. Record the name of the attending physician responsible for the patient’s assessment.
9. Provide the primary diagnosis made by the attending physician.
10. Proceed to the criteria section, where you will evaluate weight loss and BMI. Choose the appropriate options based on the patient's condition.
11. Assess food intake over the last 1-2 months and indicate any gastrointestinal symptoms that have persisted for more than 2 weeks.
12. Evaluate the patient’s functional capacity and record any related diseases that could affect nutritional requirements.
13. Conduct a physical examination and include findings on sex and any signs of edema or ascites in the respective fields.
14. Calculate the SGA grade and enter it appropriately, along with BMI and albumin levels.
15. Sum the total score based on the assessments made in previous steps to determine the risk level.
16. Select the appropriate nutritional risk level based on the total score achieved.
17. If the risk level is 3, note that a follow-up by the clinical nutrition physician is required.
18. Date your assessment and provide your signature over your printed name to confirm completion of the form.
19. Lastly, monitor the nutritional status category and indicate if a referral to the clinical nutrition dietitian is needed.

Start filling out the nutritional assessment and risk level form online today for timely and accurate evaluations.