Wic Adime

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ADIME Audit Form NUTRITION ASSESSMENT: Does the Assessment follow the IDNT guidelines for writing an assessment including: (Note: all sections may ot be required in all assessments) s) Food/Nutrition-Related History b) Biochetnical Data, Medical Tests, & Procedures c) Anthropometric Measurements d) Nutrition Focused Physical Findings e) Client History es No fe ‘sessment includes info that is succinct, relevant and appropriate to support the nuttition diagnosis (PES Statement) (Ye No \ Appropriate comparative standards used? (ce) No NUTRITION DIAGNOSIS: ‘Was a nutrition problem/diagnosis identified based on sclected data available? 3 No rent portion of the note to support a nutrition diagnosis? No AIL3 components of PES statement present using hutrtidn diagnosis, etiology(R/T) and signs/symptoms (AEB). No Diagnosis uses exact NCP terminology? —_/ Yes No Etiology is root cause that RD can resolve or reduce signs/symptoms. INTERVENTION: A nutrition prescription is written that supports the putrition diagnosis and identifies goals that are measurable, achievable and time-defined. (ss No The intervention is directed at changing the etiology but if not possible to change etiology, itis directed at reducing the impact of signs/symptoms. (Yes No a GOAL 1s patient’s goal related to the documented plan f6Tam intervention or actual intervention? fo No MONITORING AND EVALUATION: M/E component address the nuttition (ay No

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