| RESPONSES |
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- ITEM ENTRY: 1
- DIALOG: OR GTX ORDERABLE ITEM
- INSTANCE: 1
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- ITEM ENTRY: 2
- DIALOG: OR GTX WORD PROCESSING 1
- INSTANCE: 1
- TEXT:
[ ]food preferences by pt request [ ]nutrition assessment
Present Diagnosis:
Nutritionally relevant PMH/PSH:
Current diet rx:
Current albumin: Date:
Current weight (kg): Date:
H/O wt changes or problems with intake:
**** Fill in this form before transmitting ****
[ ]chewing/swallowing problems [ ]nutrient intake study (calories)
[ ]recommended oral supplements [ ]recommended diet order
[ ]malnutrition - diagnosis [ ]NPO/clear liquids > 5 days
[ ]initiate tube feeding [ ]monitor tube feeding
[ ]renal nutrition consult [ ]diet intruction
[ ]see MD re:patient [ ]schedule to nutrition class
[ ]10-1 referral [ ]outpatient nutrition education
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