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Primary Diagnosis
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Nutrition Assessment:
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Treatment Plan
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Bowels:
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Chew/Swallow
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Skin:
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OTC Medications:
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Herbal/Vitamins:
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Height:
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Current Weight:
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Ideal Weight:
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BMI:
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Usual Weight:
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Estimated Energy Needs
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Calories:
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Protein:
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Fluid:
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Nutrition Diagnosis:
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1.
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Nutrition Intervention
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1.
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2.
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Monitor/Evaluate:
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1.
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2.
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3.
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4.
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Follow Up
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Direct Patient Care Time:
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