Georgia Department of Public Health



SubjectiveWhat the participant tells you of significance to the assessment:Diet Recall, Usual Intake, Formula Intake & Tolerance (*if on infant medical formula or nutritional), Food Likes and Dislikes, Cultural Dietary InformationFamily observations of child developmentGoal Recall Report of what worked and what didn’t towards goal progressMajor family, work, medical, and social information that impact the risk, nutritional status or goal progressRecalled clinical or anthropometric data from other providersObjectiveRisk Criteria* addressed at visitWeight, (including changes in weight), %ile from Growth ChartHeight/Length or BMI %ile from Growth ChartLabsMedicationsPhysical appearance: Skin, Nails, Hair; Skin turgor and wasting; Edema; Bruises, Casts, etc.Estimated Protein/Energy needs (RD)AssessmentEvaluation* of Subjective and Objective DataFormula Intake vs. Estimated Energy NeedsGoal Progress vs. BarriersDiet history vs. Weight ChangesParticipant Stage of ChangeParticipant Motivation and goal adjustmentsNCP – Nutrition Diagnosis (If using in your district, or are in the internship)PlanInterventions* (*as applicable)Education/Encouragement providedFood Package ChangesReferrals providedMaterials providedNew Goals that are setActions: Provider, Participant, Follow-up plan ................
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