Initial nutrition assessment form 2025

1. Click ‘Get Form’ to open the initial nutrition assessment form in the editor.
2. Begin by filling out the ADx/current problems section. Clearly list any current issues or concerns related to the patient's nutritional status.
3. In the PMH (Past Medical History) field, provide relevant medical history that may impact nutritional needs.
4. Complete the Current Diet Rx and Diet PTA sections, indicating any dietary prescriptions and previous dietary habits.
5. Assess current oral intake by selecting Good, Fair, Poor, or NA in the Current PO intake field.
6. Document any food allergies or intolerances and note any changes in appetite as Increase, Decrease, or NA.
7. Fill in the anthropometric data including height (HT), weight (WT), ideal body weight (IBW), and other relevant metrics.
8. Record lab data such as albumin levels and indicate if they are within normal limits or depleted.
9. Assess nutritional risk level by selecting High, Moderate, or Low based on your evaluation.
10. Finally, complete the recommendations/plan section with follow-up details and sign off with your name/title and date/time of completion.

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