Marywood University Scranton, Pennsy!vani Department of Nutrition & Dietetics Intern Hour Reporting Form Complete this reporting form after each rotation or part of a rotation. Required Hours in: yum 160 hours + ND 565: Community Nutrition ~ m + ND 566 ; Food Systems Management ~ minimum 224 hours + NDS68: MNT fo Long Term Care ~ minimum 120 hours (© Acute Care ~ minimum 232 hours + Professional Practice following MNT: 96 hours + Altemative Practice Experiences: please specifybelow = hours Ifonly a fraction of the required hours were completed ata facility ~ please indicate that amount of hours accomplished. tem: Hay a Yoder rascompleed IFO tours carrie eoron lens Uae Soe oa Term Care Preceptor Signature: Senge ae Intern Signature: feMarywood University | Scranton, Pennsylvania Department of Nutrition & Dieenes Checklist - Long Term Care ‘Maintain all entries and records in your binder. Please have your preceptor sign below that satisfactory performance was shown inthe folowing areas. Enclose all pertinent material. The intern has: ‘ulspe~reviewed the most recent state inspection results (Disc wriuce grunt Soke die spurtoes - eodin 4L2f2_- demonsirated familiarity for the Minimum Data Set (MDS) and Care Area Triggers (CATS) Care Area Assessments (CAAS) Protocols (Puy dad ep 75 mei caa)/Drassel. U2) LuftJ2_ - competed 5 MDS quanerly assessmenis* { Dicarsert [invite d @ rdee ) . PP low tion 4 Lt cdbyrrash- Mg e 4, ) ~ completed follow vpyreassessment documentation es ef eee is tan ‘Lat Jk _- completed meal rounds, recording caloric intake and recommended ry ges as needed,* ) Clyapdd & Cely 3 yrtet biriunphye find fas} ee Vf Maye ) fete tibia tetcamie SPL Opecgh 4 thay 1 & lr a 7 dats Ci hh inde el onlotioaresym ences, 5 Ete Puy) (ita set-up amecting with OT and write areporton equipmenty Pleme (Blt bortoe?— “ 12:2-48_- coordinated the design of menus and me ions fr empate dis, ye De / ) (c Mara aud Apfersitpa fo fhe: atthe ad Bene AS Mei aan Ee ei residents and adjusted the care plans as needed. Ascusaeel. 2 Fiyren V Liye Ada. WA Ho foes Htfaa~mgpitored enteral and for parenteral fed residents ensuring needs are met Caan nde (ae 5S - Vode Cas, ay OT ce SiS ca oe on tas Llp. reviewed a Modified Barium Swallow(MBS) , Fiberoptic Endoscopic Evaluation ( FEES) OR /tij7* Video Fluoroscopic Swallow Study (VFSS) report and tracked the communication between Se eae ee po Mesa Re bh ohee bei ee oP * (virtual may review with preceptor and record findings in e-binder.)* 4d Lf 22 lor sifmaire / date