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Get Adult Day Services Client Follow-up Assessment - Pitt

Weight: A Height ( in inches) B Weight (in poun ds) 3. Regularly complains of hunger d uring the last week: 1 2 5. Check all A B C D E 2. Weight change: 1 2 Loss of 5% or more in p ast 30 days Gain of 5% or more in p ast 30 days 4. Leaves 25% or more uneaten at most meals during the last week: Yes No 1 2 Yes No that apply during the last week: Parental/IV Feeding tube Dietary sup plement b etween me als On weight change program Other:.

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