NUTRITIONAL ASSESSMENT AND RISK LEVEL FORM 2025

1. Click ‘Get Form’ to open the NUTRITIONAL ASSESSMENT AND RISK LEVEL FORM in the editor.
2. Begin by entering the 'Date Admitted', 'Room / Bed No.', and 'File No.' at the top of the form. This information is essential for patient identification.
3. Fill in the patient's personal details, including their name, age, height, and weight. Accurate data here is crucial for assessing nutritional needs.
4. In the 'Criteria' section, evaluate weight loss and BMI. Select appropriate options based on clinical observations to determine risk levels.
5. Assess food intake over the last 1-2 months and any gastrointestinal symptoms experienced by the patient. Document these findings clearly.
6. Complete the 'Physical Examination' section by noting any edema or ascites present and assigning an SGA Grade based on your assessment.
7. Calculate the TOTAL SCORE based on previous entries to determine the NUTRITION RISK LEVEL. Mark whether it’s Level 1, 2, or 3 accordingly.
8. Finally, ensure that both you and the attending physician sign off on the form with dates to validate its completion.

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