Table of Contents
     Introduction                                                                                            Page
     Dietary Policy & Procedure Manual Approval
     Nutritional Care/Diets
     Diet Manual                                                                                                 1
     Diet Terminology for Nutrition Prescriptions (Diet Orders)                                                  2
     Notification of Nutrition Prescription Changes/Communication                                                3
          Diet Conversion Guide from NDD                                                                         4
          Diet Communication from NDD                                                                            5
     Mechanically Altered Diets from NDD                                                                         6
     Thickened Liquids from NDD                                                                                  8
          Diet Conversion Guide from IDDSI                                                                      10
          Diet Communication from IDDSI                                                                         12
     Mechanically Altered Diets from IDDSI                                                                      13
     Thickened Liquids from IDDSI                                                                               15
     Diet Cards/Tray Tickets                                                                                    17
     Liberalized Diets                                                                                          18
     NPO Nutrition Prescriptions                                                                                19
     Fluid Restriction                                                                                          20
          Hydration Provided by Regular Diet                                                                    22
          Fluid Restriction Form                                                                                23
     Packed Meal/Snack for Hemodialysis Treatment                                                               24
     Finger Food Diet                                                                                           26
     Salt Substitute                                                                                            27
     Altered Portions                                                                                           28
     Six Small Meals                                                                                            30
     Nourishing Alternative Meals and Snacks                                                                    31
     Food Intake Records                                                                                        32
          Food Acceptance Record                                                                                33
     Pleasure Feedings                                                                                          34
     No Milk/Milk Product                                                                                       36
     Food Allergies/Intolerances                                                                                40
     Diet Holiday                                                                                               42
     Assistive/Adaptive Devices                                                                                 43
     Nutrition and Hydration Intervention Guidelines                                                            44
     Super Nutrition/Fortified Foods Program                                                                    46
     Supplements and Snacks                                                                                     47
          Nutritional Supplement and Snack List                                                                 49
     Nourishing Bedtime Snacks                                                                                  50
     Alternate Meal Options                                                                                     51
     Guidelines for the use of Feeding Tubes                                                                    53
     Total Parenteral Nutrition                                                                                 56
     Diet Education                                                                                             58
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                                                 Table of Contents
    Documentation
    Confidentiality of Dietary Records/HIPAA                                                          65
    Nutrition Documentation Overview                                                                  67
         Time Frame Guidelines for Nutrition Documentation                                            70
    Resident Interview/Food Preferences                                                               71
         Resident Interview/Food Preferences                                                          72
    Nutrition Care Process Overview                                                                   73
         Nutrition Care Process Steps and Domains                                                     75
    Guidelines for Completing a Comprehensive Nutrition Assessment                                    76
    Guidelines for Completing the Nutrition Assessment Form                                           78
         Nutrition Assessment                                                                         82
    Calculation of Nutrition and Hydration Needs                                                      83
    Interpretation of Laboratory Data                                                                 87
    Guidelines for Completing the Nutrition Risk Assessment Form                                      88
         Nutrition Risk Assessment                                                                    89
    Guidelines for Completing the MDS 3.0 Section K                                                   90
         MDS 3.0 Section K                                                                            99
    Guidelines for Completing the Care Area Assessment (CAA)                                         100
    Dietary Care Plans                                                                               102
    Quarterly Assessment                                                                             104
    Dietary Progress Notes                                                                           106
         Dietary Progress Notes                                                                      108
    Guidelines for Completing the Enteral Feeding Worksheet                                          110
         Enteral Feeding Worksheet                                                                   113
    Guidelines for Enteral Feeding Orders                                                            115
    Weight Protocol                                                                                  116
         Monthly Weight Record Log                                                                   118
         Resident Weight Record                                                                      120
    Guidelines for Completing the Significant Weight Variance Report Form                            121
        Significant Weight Variance Report                                                           122
    Calorie Count                                                                                    123
         Calorie Count Worksheet                                                                     124
    Nutrition at Risk Program                                                                        125
         Nutrition at Risk Tracking Log                                                              129
         Nutrition at Risk Resident Monitoring                                                       130
         Nutrition at Risk Program Committee Minutes                                                 132
    Individual Nutrition Recommendations/Response Form                                               133
         Individual Nutrition Recommendations/Response                                               135
    Refusal of Treatment/Informed Consent Form                                                       136
         Refusal of Treatment/Informed Consent                                                       138
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                                                   Table of Contents
    Clinical Consultation
    Nutrition Professional Communication Checklist Form                                                 145
         Nutrition Professional Communication Checklist                                                 146
    Nutrition Recommendations Form                                                                      147
         Nutrition Recommendations                                                                      149
    Consultant Report Form                                                                              150
         Consultant Report                                                                              152
    Monthly Food and Nutrition Services Quality Assurance Report Form and Meeting                       153
         Monthly Food and Nutrition Services Quality Assurance Report                                   154
    Dietitian Notebook                                                                                  155
        Pressure Injury Log                                                                             158
        Enteral Feeding Log                                                                             159
        Dialysis Log                                                                                    160
        Assisted Living Log                                                                             161
    Dietitian Referral Checklist                                                                        162
        Dietitian Referral Checklist                                                                    164
    Menus, Food Production & Preparation
    Approved Food Sources                                                                               175
    Safe Handling of Food Brought in by Outside Sources for Resident Consumption                        176
        Visitors Providing Food to Residents                                                            178
    Food Ordering                                                                                       179
        Vendor Information Form                                                                         180
    Receiving                                                                                           181
    Cross-Contamination Overview                                                                        182
    Cross-Contamination Prevention                                                                      185
    Date Marking                                                                                        187
    Potentially Hazardous Food or Time/Temperature Control for Safety Food Overview                     189
    Storage of Potentially Hazardous Food/Time/Temperature Control for Safety Food                      191
    Food Safety in Highly Susceptible Populations                                                       192
    Refrigerated Storage                                                                                193
    Frozen Storage                                                                                      196
    Dry Storage and Supplies                                                                            197
         Storage of Food Guidelines                                                                     199
    Meat Storage and Preparation                                                                        208
    Fruit Storage and Preparation                                                                       210
    Vegetable Storage and Preparation                                                                   211
    Milk Storage and Preparation                                                                        212
    Egg Storage and Preparation                                                                         213
    Production Guides                                                                                   215
         Production Guide                                                                               216
    Diet Census                                                                                         218
    Frequency of Meals                                                                                  219
    Menus                                                                                               220
    Posted Menu                                                                                         221
    Standardized Recipes                                                                                222
    Portion Control Guidelines                                                                          223
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                                                    Table of Contents
     Menus, Food Production & Preparation (Continued)
          Guide to Portion Control Equipment                                                              224
          Guide to Steam Table Pans                                                                       225
          Guide to Baking Pan Yields                                                                      226
          Guide to Can Sizes                                                                              227
     Therapeutic Diet Spreadsheet                                                                         228
     Accomodation of Food Preferences                                                                     229
     Selective Menus                                                                                      230
     Menu Substitutions                                                                                   231
          Substitution Lists                                                                              233
          Substitution Log                                                                                242
     Menu Alternates                                                                                      243
     Food Presentation                                                                                    244
     Garnishes                                                                                            245
     Thermometer Storage, Testing, Calibration and Sanitization                                           246
     Thermometer Testing/Calibration Record                                                               248
          Thermometer Testing/Calibration Record                                                          249
     Recording Final Cooking Food Temperature                                                             250
          Final Cooking Temperature Guideline                                                             251
          Final Cooking Temperature Record                                                                252
     Taste Testing                                                                                        253
     Holding Food Temperatures and Guidelines                                                             254
          Holding Food Temperature Record- Breakfast                                                      256
          Holding Food Temperature Record- Lunch                                                          257
          Holding Food Temperature Record- Dinner                                                         258
     Thawing                                                                                              259
     Cooling                                                                                              260
     Cooling Temperatures Audit Record                                                                    261
          Cooling Temperatures Audit Form                                                                 262
     Leftovers                                                                                            263
     Reheating Food                                                                                       264
     Produce Gardens                                                                                      265
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