Nutrition Assessment
Precisely assess the nutritional needs of your patients and streamline your documentation process using our comprehensive and formatted nutrition assessment form.
What Is A Nutrition Assessment Form
Assessing the nutrition status of your patient can be a very important step in making treatment decisions for your patient. There can be many reasons someone may require a nutritional assessment, such as for restoring weight following a medical treatment, helping a client to achieve a healthy weight through weight loss, assessing the degree of any malnutrition present in a patient, or a starting point for planning interventions to improve a patient’s diet or nutrition.
A nutrition assessment form is designed to help standardize this process by ensuring you cover the whole range of information that could be relevant to your patient’s nutritional status. This form serves as both a skeleton for the evidence you gather for your patient’s nutrition assessment, and as a structure for the assessment itself. You can plan your nutrition assessment session by moving through the four main sections, anthropometric, biochemical, clinical, and dietary assessments, and ensure you gather information for each.
Printable Nutrition Assessment Form
Check out these Nutrition Assessment Form templates to improve your intake process and client experience.
How To Use This Template For Nutrition Assessment Forms
This nutrition assessment form might look like a big undertaking at first glance, but we’ve created a simple step-by-step guide to help you get comfortable conducting nutrition assessments using this template. Just follow these steps to get started.
Patient Information
The patient information section is key for getting down your patient’s contact and demographic information. This is important for identifying your patient, and for contact purposes down the road.
Anthropometric Assessment
The anthropometric assessment is the section for your patient’s measurements. Ensure your measurement equipment is accurate enough to get precise measurements. The measurements you choose to take are up to you, and we have left a section for any extra measurements you wish to note down. Indices such as IBW, ABW, TDEE or CRCL can be noted in this section as well if you choose to calculate them.
Biochemical Assessment
The biochemical assessment refers to your patient’s lab results, and conclusions you can draw from these results. Relevant lab results might include liver function tests, hbA1c results, blood sugar tests, CBC count, or serum protein tests.
Clinical Assessment
The clinical assessment is designed to be completed using the information gathered from your session with the patient. This includes your patient’s risk factors, allergies, physical findings, activity level, and pertinent medical history.
Dietary Assessment
The dietary assessment is a key part of any nutritional assessment. There are many ways to conduct a dietary assessment, but here we have included a 24-hour recall dietary assessment. This is because it tends to be more accurate and quicker to finish than other methods of dietary assessment such as food frequency questionnaires. It’s important when filling in this section to remain unjudgmental towards your client, and to emphasize there are no “good” or “bad” foods and they should be honest about what they ate.
Sign, Date, and Store Securely
The last step is to sign your name, add the date and store this document somewhere secure due to the confidential patient health information it contains.
Nutrition Assessment Form Example (Sample)
Take a look at our example nutrition assessment to get a better idea of how our form works. While every client’s nutrition assessment will look different, we’ve provided just one example of how this nutrition assessment form could be filled out.
Nutrition Assessment Form Example (Sample)
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Who Can Use this Printable Nutrition Assessment Form (PDF)?
Our ADIME Note template was designed with Registered Dietitians (RDs) and Registered Dietitian Nutritionists (RDNs) in mind.
There are a wide variety of dietetic specialties that can benefit from using our nutrition assessment form template, including:
- Pediatric Nutrition
- Sports dietetics
- Obesity and weight loss nutrition
- Oncology nutrition
- Geriatric nutrition
- Public health nutrition
As well as RDs and RDNs, any healthcare worker wanting to assess the nutritional status of their patient can benefit from using our nutrition assessment form, such as registered nurses, resident physicians, or social workers.
Why Is This Form Useful For Dietitians
Spaces for additional notes
We know that one template can’t work for everyone, and so to customize the information you include- we’ve added space for additional notes you wish to take down. These spaces are included at the end of each section, so you can keep your nutrition assessment organized.
Keep it digital
One great advantage of this nutrition assessment form is that it can be filled in and stored completely digitally. The PDF is easy to complete, just click in the interactive text boxes and start typing. Keeping your nutrition assessment digital is great for improving security, and accessibility, and saving time on handwriting or fixing errors by hand.
Benefits of Nutrition Assessment Form Templates
Non-region specific
Regardless of the units you prefer, this template will work for you. Take measurements in feet, inches, meters, centimeters, or even furlongs, as long as you are consistent with what you use, and adjust how you calculate unit-specific indices such as BMI.
Comprehensive
Our nutrition assessment form covers four key sections, as well as includes space for your patient’s information, additional notes, additional anthropometric measurements, and your signature and date.
Includes dietary assessment
Use one template for your client’s nutrition and dietary assessments with the included 24-hour recall table at the end of this template. You can save time hunting for multiple different forms for your client, and your client can get their assessment done in a single session- a win-win for both of you!
Standardize your nutrition assessments
It’s important you ask every client certain questions every time you see them to ensure you have identified key information such as allergies, risk factors, or medication they are currently taking. Having a template to remind you of the questions to ask during the nutritional assessment is a great way to standardize the way you interact with your patients, and ensure you are giving each patient the best possible treatment in their session with you.
Include your patient information
Don’t forget key details like your patient’s date of birth or address again! With dedicated spaces in our patient information header, you can ensure the nutrition assessment will be filed under the correct patient- whether that’s digital or old-school filing!
Commonly asked questions
The four components of a nutritional assessment can be remembered by ABCD. These are Anthropometric, Biochemical, Clinical, and Dietary Assessments. Some nutrition assessments will go further do include food security assessments, environmental factors, or a separate evaluation section. We have included note sections throughout this template to allow you to take down additional information if you wish.
The pertinent medical history is for the parts of your patient’s medical history that are relevant to their level of nutrition. It’s up to your clinical judgment to determine what to include, but ultimately, if it has no bearing on your patient’s nutrition and you deem it irrelevant- you can leave it out.
For this task, your client is asked to remember everything they ate or drank in the 24 hours prior. You might prompt them to remember using phrases such as “what did you eat before getting into bed?”, or “what did you eat just after you woke up?” to help them to remember. Additionally, you should ensure you refrain from showing judgment through your expressions or verbally to avoid influencing your client’s answers. This assessment can be repeated multiple times at different sessions to build up a better picture of your client’s eating habits.
Why Use Carepatron For Nutrition Assessment Form?
Carepatron might just be the all-in-one solution you’ve been looking for to take your dietitian or nutritionist practice to the next level. Here are just a few of the ways Carepatron can simplify your practice’s administration and save you time, so you can get back to doing what you do best.
- Automated appointment reminders: Reduce no-shows and optimize your time using Carepatron’s automated SMS or email appointment reminders.
- Patient Portal: Offer your clients their own Carepatron portal to book appointments, manage payments, and access their records.
- Smart dictation: Prefer to dictate your notes than type? We have you covered with our AI-powered dictation software, compatible with all Carepatron’s templates, including the nutrition assessment form.
- Manage payments and billing: Unify your practice’s calendars, your patient’s appointment scheduling, and your billing and payments all from within Carepatron.
- Community template library: Finally, you can access this template and many more, right from within Carepatron. Find one you like, and store the completed version in our HIPAA-compliant, digitally encrypted EHR system.
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