Menu Selections   Set Select Menus   UpLoad Picture   Fluid Restriction   Password Card    Select Worksheet                                                                Setup Select Menus
 Rm    Name  Resno Age  SxFM  Hgt444546474849505152535455565758596061626364656667686970717273747576777879in.  IBWR  AdjIBWR  Set:  Col:  Wdy:    
ADt DOB NMP Sel Ph BMI: BEE:0 Wgt:  ADE  Fc L Bdy Edy PCC
   Bk RMCT1CT2WC1WC2D11RESDR1DR2DR3DR4DR5DR5DR7DR8DR9D10D11D12D13D14D15D16RS1RS2not   Lh RMCT1CT2WC1WC2D11RESDR1DR2DR3DR4DR5DR5DR7DR8DR9D10D11D12D13D14D15D16RS1RS2not   Sp RMCT1CT2WC1WC2D11RESDR1DR2DR3DR4DR5DR5DR7DR8DR9D10D11D12D13D14D15D16RS1RS2not  Wmk:      Save PIN:
.  LIKES:
       
       
       
       
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.  DISLIKES:
       
       
       
       
   

 Alleregies:       

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  B    L     S    Beverage Preferences:
 Coffee
 Decaf
 Hot Tea
 Orange Jce
  B    L     S 
 Apple Jce
 Cranbry Jce
 Prune Jce
 Iced Tea
  B    L     S 
 Whole Milk
 LowFat Milk
 Skim Milk
 Choc Milk
  B    L     S 
 Butter Milk
 Soy Milk
 Tomato Jce
 V-8 Juice
  B    L     S 
 Grape Jce
 GrapeFrt Jce


 No Spices        No Caffeine           Hi Fiber
 Finger Food     Aspiration Prec.     Red Napkin Prg    
 Anemia            Enc. Protein 
 
 
.   Breakfast Tolerances_________________________________Lunch Tolerances__________________________________Supper Tolerances
     
     
     
     
     
     

.   10 am Nourishments__________________________________2pm/3pm Nourishments___________________________HS Nourishments     
     
     
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.  Medications: 

   





 
 Tray Card Top Diagnosis Weights Labs Skin Meals/IOs NPA RDCDMAssessment FaxRec  WgtInput

One Time Font Download to View Tables Below


  Diagnosis:


ICD9-1:    ICD9-7:
ICD9-2:    ICD9-8:
ICD9-3:    ICD9-9:
ICD9-4:    ICD910:
ICD9-5:    ICD911:
ICD9-6:    ICD912:
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 Tray Card Top Diagnosis Weights Labs Skin Meals/IOs NPA RD CDM Assessment FaxRec  WgtInput

  Diet History & Tubefeeding  BEE and BMI 
0     
Tubefeeding Formulas   Select from List to Change


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-2_
TF Regimen:  M1:  O1:  M2:  O2:  M3:
Flush Regm:  M1:  O1:  M2:  O2:  M3:
Activity Fctr:  Stress Fctr:  Protein Fctr:  Adjust1:  Adjust2:
 Roster  Rebuild Wts  BatchWts ProxyWgts
Tray Card Top Diagnosis Weights Labs Skin Meals/IOs NPA RD CDM Assessment FaxRec  WgtInput Clear 15 Wts



WEIGHTS:      Diet:     IBWR:-264--244   Current Wgt:
Del
 Date 
Weight
% Chg
 Kg 
 Scale
 Wgt Change 
 30 day % 
 90 day % 
 180 day % 
 CP 
X=Lock
Ins



 Roster  Rebuild Wts  BatchWts 

Tray Card Top Diagnosis Weights Labs Skin Meals/IOs NPA RD CDM Assessment FaxRec  WgtInput



     Diet:     IBWR:-264--244   Current Wgt:
LABS: 
Del
  Date 
  Hb 
  Hct 
  Alb 
  Glu 
  BUN 
  Cre 
  K+ 
  Chol 
  Na 
  Cl- 
 Osmk
 Misc
Ins
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Tray Card Top Diagnosis Weights Labs Skin Meals/IOs NPA RD CDM Assessment FaxRec  WgtInput


     Diet:     IBWR:-264--244   Current Wgt:
Skin Assessments: 
Del
  Date 
 AdW 
 Location
 Stg 
 Len 
 Wdth 
  Dep 
  Wk 
PVE Codes
  OD 
Trt Codes
 Dt Acqrd
Dt Fam/MD
  M 

 
 
 Roster Tray Card Top Diagnosis Weights Labs Skin Meals/IOs NPA RD CDM Assessment FaxRec  WgtInput


  Nutrition Protocol Assessment


 Nutrition Diagnosis:
Not Enough Calorie Intake related to weight loss
Difficulty Feeding Self
Not Enough Protein Intake related to increased protein needs
Too Many Calories Consumed related to excessive weight gain
Insufficient Intake from Enteral Nutrition in compared to calculated needs
Insufficient Fluid Intake from Enteral Nutrition compared to calculated needs
Insufficient Fiber Intake related to constipation
 
 
 Nutrition Interventions:
 Meals/Snacks 
Nutritious Diet
Intervention with foods, amounts, times, snacks
Specific Changes in Foods and/or Beverages
 
 Enteral Nutrition 
Begin Tubefeeding
Modification in TF regimen
Discontinue Enteral/Parenteral Nutrition
 
 Supplements/Snacks
Fortified Foods
House Supplement
Commercial Supplement

 
 Vitamin/Mineral Supplements 
MVI w/minerals
Iron Supplement
Calcium Supplement
Vitamin D Supplement

 
 Assist with Feeding
Adaptive Equipment
Positioning During Meals
Meal Setup

 
 Dining Environment
Adjust Lighting
Adjustment Table Height
Reduce Distractions
Adjust Table Service/Setup
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Tray Card Top Diagnosis Weights Labs Skin Meals/IOs NPA RD CDM Assessment FaxRec  WgtInput