NH template

[Face to face or telephone] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) consultation to [Name and role of staff member present] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) at [Name of care or nursing home](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) [Names and roles of any other individuals present at the visit](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Patient seen in best interest. Referred on [Date of referral] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) by [Name and role of referrer] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) for [Reason for referral](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Anthropometry Most recent weight: [Most recent weight in kg](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Height: [Height in cm and/or feet and inches](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) BMI: [Body mass index](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) MUST: [MUST score and category](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Weight history: [Previous weight recordings with dates](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) MUAC: [Mid-upper arm circumference in cm with date of measurement](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Anthropometry impression: [Clinical impression of anthropometry including percentage weight loss in the last 3 and 6 months, when weight loss started, and причин if known](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Biochemistry: [Relevant laboratory values](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) BMs: [Blood glucose or BM readings](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Clinical: [Recent clinical updates including any hospitalisations, scans, investigations, visits or comments from other professionals, infections, or other clinically relevant events](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) PMHx: [Past medical history](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Relevant medications: [Current medications](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Nutritional supplements: [Supplement name, energy in kcal, protein in grams, and volume in ml](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Capacity: [Whether the patient has capacity — yes or no](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Skin integrity: [Current skin status and any pressure areas or wounds](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Dentition: [Condition of teeth, dentures, and oral health](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Bowels: [Bowel habit including frequency and consistency](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Mobility: [Current mobility level and any mobility aids used](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else keep heading but leave blank.) Social History [Summary of social situation including residency status, family visits, and social interactions](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Dietary Is patient on fortified diet? [Yes or no](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Assistance with eating? [Yes or no, and nature of assistance if described](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Allergies: [Known food and drug allergies and nature of reactions](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) IDDSI: [SALT review date, recommended IDDSI fluid level and diet level. If not known to SALT, write "Normal diet and fluids - not known to SALT"](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Dietary intake Breakfast: [Breakfast details](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Mid-morning snack: [Mid-morning snack details](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Lunch: [Lunch details](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Mid-afternoon snack: [Mid-afternoon snack details](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Evening meal: [Evening meal details](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Supper: [Supper or evening snack details](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Fluid intake: [Total daily fluid intake](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Diet summary: [Qualitative summary of overall dietary intake and patterns](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Estimated nutritional intake: Energy – [Total estimated kcal] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) kcal, Protein – [Total estimated protein in grams] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) g, Fluids – [Total estimated fluid in ml] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) ml Estimated nutritional deficit: [Estimated energy deficit in kcal] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) kcal, [Estimated protein deficit in grams] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) g protein, [Estimated fluid deficit in ml] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) ml Daily estimated nutritional requirements based on [Most recent weight in kg] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) kg: Energy: [Energy requirement per kg based on BMI: 20–25 kcal/kg if BMI above 18.5, or 25–30 kcal/kg if BMI below 18.5] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) kcal/kg x [Physical activity level: 1, 1.1, 1.2, or 1.4] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) PAL = [Total energy requirement in kcal] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) kcal Protein: 1.2–1.5 g/kg = [Total protein requirement in grams] g(Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Fluid: 30 ml/kg = [Total fluid requirement in ml] ml(Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Consultation summary: [Summary of the key points discussed during the consultation](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) PASS Statement: [Dietetic problem] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) related to [aetiology] (Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) as evidenced by [signs and symptoms](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Aim: To optimise oral intake to support weight gain and prevent further nutritional losses via a food first approach and oral nutritional supplements. Plan 1. [First plan point](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) 2. [Second plan point](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) 3. [Third plan point](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) 4. [Fourth plan point](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) 5. [Fifth plan point](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) 6. [Sixth plan point](Only include if explicitly mentioned in the transcript, contextual notes, or clinical note, else omit section entirely.) Discharge Plan: Discharge patient from the Community Nutrition Support Service. Please refer to the service if there is: - Further weight loss of greater than 5% within the next 3–6 months - Development of a pressure ulcer grade 2 or above If oral nutritional supplements are not tolerated, the GP should review and manage accordingly.(Only include if oral nutritional supplements are included in the plan, else omit this sentence entirely.)