Form from HIS OpenVistA

  1. 2/25/12 2/25/12 -
  2. 8/9/14 8/9/14 - Martin Dugas
  3. 6/25/15 6/25/15 - Martin Dugas
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June 25, 2015

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Creative Commons BY-NC 3.0 Legacy
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  1. StudyEvent: HIS
    1. HIS
Patient sex
Patient triggered for problem swallowing difficulty
Patient states no problems with swallowing difficulty
Swallow difficulty due to sore throat. Nursing Notified.
Patient needs diet consistency change to diet.
Patient needs special foods of appropriate consistency.
Patient triggered for poor po intake > 5 days.
Patient states no problems with po intake.
Patient states po intake improved>50% at all meals.
Patient states no appetite.
Patient started on nutrition support
Patient triggered for unintentional weight loss of 10 pounds or more in 3 months.
Patient states no weight loss.
Patient was on a diet, weight loss was intentional.
Patient states weight loss due to increased activity.
Patient triggered for food allergies
Patient states they have no food allergies/intolerances.
All food allergies/intolerances were identified.
Patient triggered for being pregnant and less than 16 years old of age.
Patient is greater than 16 years old of age.
Patient is not pregnant.
Patient triggered for being pregnant and on special diet.
Patient is not pregnant.
Patient is not on a special diet.
Patient understands special diet, does not need additional information.
Patient does not understand special diet.
Patient triggered for being below 10th percentile of Pediatric Growth Charts.
Patient is at 50th percentile or greater on growth charts.
Patient is between 25th and 50th percentile on growth charts.
Patient seen due to extended length of stay in hospital.
Patient to resume po intake (if currently NPO).
Patient to transition to solid foods (if on CL or FL diet).
Patient to be provided foods of appropriate consistency to decrease swallowing difficulty.
Patient to continue po intake>75% at meals/snacks.
PO intake to be greater than 50% at all meals/snacks.
Weight gain of 1-2 lbs per week.
Patient will not receive foods that they have indicated as being allergic or intolerate to.
Patient to understand diet currently ordered by physician.
Continue with diet as currently ordered.
Advance diet as tolerated.
Explain menu process. Encourage continued good intake > 50%.
Encourage patient to mark menu selections.
Obtain food preferences. Place in computer and notify kitchen.
Discuss adding oral supplement with nursing or dietician.
Provide snacks to increase po intake.
Notify diet office of food allergens or intolerances via computer.
Provided educational handout on diet. Give RD contact information for further questions.
Inform dietician of need for extensive diet education on diet.
Follow patient per protocol.
Refer to dietician

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