Stacy CLIFF Pt- Gestahbmal Clialeles ADIME Audit Form NUTRITION ASSESSMENT: Does the Assessment follow the IDNTT guidelines for writing an assessment including: (Note: all sections may not be required in all assessments) a) Food/Nutrition-Related History b) Biochemical Data, Medical Tests, & Procedures ¢) Anthropometric Measurements d) Nutrition Focused Physical Findings ¢) Client History Yes No Assessment includes info that is succinct, relevant [ee to support the nutrition diagnosis s ¥ (PES Statement) No Appropriate comparative standards used? & No Unedle- Num hun Meemurindaayn sy NUTRITION DIAGNOSIS: Was a nutrition problem/ diagnosis identified based on selected data available? Gs No. Is there initial documented evidence in the Assessment portion of the note to support a nutrition, diagnosis? Yes, No All 3 components of PES statement present using nutrition diaggosis, eiology(R/T) and signs/symptoms (AEB). ves No Diagnosis uses exact NCP terminology? ws) No Etiology is root cause that RD can resolve or reduce signs/symptoms. Ye) No INTERVENTION: ‘A nutrition prescription is written that supports the nutrition sis and identifies goals that are measurable, achievable and time-defined. (es) No The intervention is directed at changing the etiology but if not possible to change etiology, itis directed at reducing the impact of signs/symptoms. ¥ No GOAL Is patient’s goal related to the documented plan far-ag intervention ot actual intervention? Goal folloy real patkinn Qe ) Re mt © Ge MONTTORING ANS ANALUATION: M/E component addresses the nutrition (Yes No