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HOMES AND SENIORS SERVICESPOLICY & PROCEDURE NUMBER: 4.18 DEPARTMENT: DietarySUBJECT: Dysphagia ManagementAPPROVAL DATE: August 1985 REVISION DATE: January 2015 REVIEW DATE: May 2018; Oct 2019; Dec.2020Page
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To fill out dysphagia in form elderly, follow these steps:
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Begin by obtaining a copy of the dysphagia form specifically designed for the elderly.
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Read the instructions on the form carefully to familiarize yourself with the information needed.
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Start by filling out the personal information section, including the patient's name, age, gender, and contact details.
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Move on to the medical history section and provide details about any relevant medical conditions or surgeries the elderly person has undergone.
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Answer the questions related to dysphagia symptoms. Be as specific as possible and provide accurate information.
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If applicable, include information about any medications the elderly person is currently taking that may affect their swallowing ability.
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Fill out the dietary restrictions section, outlining any specific food and liquid restrictions recommended by a healthcare professional.
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If known, include information about any underlying causes of dysphagia, such as stroke, Parkinson's disease, or cancer.
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Finally, review the completed form for accuracy and ensure all required fields are filled out.
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Submit the form to the appropriate healthcare provider or facility as instructed.

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Dysphagia in the elderly refers to a swallowing disorder commonly affecting older adults, characterized by difficulty in swallowing food, liquids, or medications.
Health care providers, caregivers, or healthcare professionals who assess and recognize dysphagia in elderly patients are required to file the dysphagia form.
To fill out the dysphagia form for the elderly, collect patient information, document symptoms observed, include any dietary restrictions, and provide recommendations for care.
The purpose of the dysphagia form for the elderly is to ensure accurate diagnosis, treatment planning, and to communicate specific needs for managing swallowing difficulties.
Information that must be reported includes patient demographics, medical history related to swallowing issues, observed symptoms, and any adaptations made for feeding.
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