Get the free FEEDING EVALUATION HISTORY FORM - UK HealthCare - ukhealthcare uky
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UNIVERSITY OF KENTUCKY
SPEECH LANGUAGE PATHOLOGYFEEDING EVALUATION HISTORY FORM
Name Date of BirthPrimary Caregiver (s)AddressPhone #1
Phone #2EmailPrimary Care PhysicianAdditional Care ProvidersMedical
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How to fill out feeding evaluation history form
How to fill out feeding evaluation history form
01
Start by gathering all relevant information about the individual's feeding habits, preferences, and any medical history that may impact their ability to eat.
02
Fill out the sections of the form that pertain to the individual's current dietary intake, including the types of foods they eat, the quantity, and any supplements they may be taking.
03
Record any feeding issues or concerns that have been observed, such as difficulty swallowing, choking, or refusing certain foods.
04
Provide details about the individual's feeding environment, including the settings in which meals are typically served and any adaptive equipment that is used.
05
Collaborate with other healthcare professionals as necessary to gather additional information and ensure all aspects of the individual's feeding evaluation are thoroughly documented.
Who needs feeding evaluation history form?
01
Individuals who are experiencing feeding difficulties or are at risk of malnutrition may need a feeding evaluation history form.
02
This form may be used by healthcare professionals such as dietitians, speech therapists, and physicians to assess an individual's feeding habits and develop appropriate interventions.
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What is feeding evaluation history form?
The feeding evaluation history form is a document used to record and assess the feeding habits and history of an individual.
Who is required to file feeding evaluation history form?
Healthcare professionals such as dietitians, nutritionists, and doctors are typically required to file the feeding evaluation history form.
How to fill out feeding evaluation history form?
The form should be filled out by providing detailed information about the individual's feeding habits, preferences, allergies, and any medical conditions that may affect their diet.
What is the purpose of feeding evaluation history form?
The purpose of the feeding evaluation history form is to gather information that can help healthcare professionals create personalized dietary plans and assess nutritional needs.
What information must be reported on feeding evaluation history form?
Information such as food allergies, dietary restrictions, food preferences, medical conditions affecting diet, and any recent changes in weight or appetite must be reported on the feeding evaluation history form.
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