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If DMAP insurance RN home visit to evaluate appropriateness of home setting and instruct on tube feeding. Docx Revised 10/27/16. Tube Type and Diet Order Date of Placement Feeding Tube PEG PEG/J PFG PFG/J NG NJ French Size Diet order NPO- or ORDERS Orders Per Physician Does the patient have a potential for refeeding syndrome Yes No Needs Assessment If yes order a NUTRITION PANEL including CMP phosphorus magnesium CBC every three days after initiation of the tube feeding until goal rate is...

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