NUTRITIONAL ASSESSMENT AND RISK LEVEL FORM 2026

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 crucial for patient identification.
3. Fill in the patient's personal details, including their name, age, height, and weight. Accurate data here is essential 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. Document findings clearly to provide a comprehensive overview.
6. Complete the 'Physical Examination' section by noting any edema or ascites and calculating scores for SGA Grade, Albumin levels, and TLC.
7. Finally, review the total score to determine the NUTRITION RISK LEVEL and indicate if a referral to a Clinical Nutrition Dietitian is necessary.

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