308 lines
9.0 KiB
Plaintext
308 lines
9.0 KiB
Plaintext
English French Notes Complete/Exclude
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ADJUSTED MEASURED
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Average Daily
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Meals/Adj Measured FTEE
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FTEE Summary
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Enter Cumulative Total on the 830 Report of Costs
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REQUIRED FIELD!
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Tech (1019)
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Dietitians (1018)
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Wageboard (1008)
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Clerical (1002)
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Total Personal Cost
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Subsistence (2610)
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Operating Supp (2660)
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All Other
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COST PER MEAL
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Average Cost Per Meal
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COST PER DIEM
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Avg Tot
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Personal Services
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Select SURVEY CATEGORY
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Select one of the questions on the Dietetic Survey.
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Select SERVICE
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Enter the Service you want to enter or edit.
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Enter Rating String
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Enter More Rating String for another service ?
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Two spaces found in input
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Illegal String Specification in
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No number surveyed for
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Illegal entry in rating
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cannot be greater than 9999
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used more than once.
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There are only 5 ratings.
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List the numbers surveyed by specifying which rating it belongs
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to and separated by a single space.
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Example: E20 V40 G40 F3 U1
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E = Excellent, V = Very Good, G = Good, F = Fair and U = Unacceptable
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Omit if none surveyed for a certain rating.
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Appetizing
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Foods Preferred
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Hot Enough
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Cold Enough
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Courteous
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Preferences Discussed
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Timeliness
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Enough Time to Eat
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Nutritional Info
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Overall
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GM&S
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DIETETIC SURVEY
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YTD Rtng
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Num Rtng
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ToT Avg
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Print the Dietetic Annual Report
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This is a very long and time consuming
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report, it must be queued to print.
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October^January January^April April^July July^October
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Error! Wrong Qtr
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Qtr FY
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Already Purged to
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Purge To The Year:
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CANNOT PURGE TO YEAR THAT IS GREATER THAN THE DEFAULT!
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NUTRITION CLASSIFICATIONS
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NUTRITION PLANS
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ENCOUNTER TYPES
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Enter a NEW Encounter (Y/N)?
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DATE/TIME OF ENCOUNTER:
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Enter Date of Encounter you want to edit:
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CHOOSE CLINICIAN or PATIENT
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Select CLINICIAN:
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No encounter on file on this date
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Select number you want:
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Select only a number no greater than
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or press
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or a return to exit.
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<encounter deleted>
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Patient has expired.
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No Encounter on file for this patient.
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Is this correct? Y//
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Answer YES or NO
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You can ONLY DELETE an encounter that is entered by you.
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Want to delete encounter? N//
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Statistics for ALL Clinicians? Y//
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Break-down by Clinician? Y//
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List Individual Patient Encounters? N//
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[Cannot Start after Today!]
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[Must Not enter date greater than Today!]
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TOTAL ENCOUNTERS
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Subtotal
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Number Inpatients Outpatients Others Total
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Pat Col Units Pat Col Units
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Persn Units Persn Units
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[ Patient has expired. ]
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No Encounters on file for this patient.
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Display Encounters Since:
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No Encounters recorded since
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Clinician:
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Individual
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Entered :
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Reviewed :
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You may enter an A to calculate weight anthropometrically.
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Date Weight Taken:
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Usual Weight:
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Enter height as: 6' 2
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or 74IN or 6FT 2 IN or 30CM
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Add an S if height is stated rather than measured.
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Add a K if value is a Knee Height measurement.
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Height should be between 12
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Enter Weight as 150# or 150# 6OZ or 800G or 70KG
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Add an S if weight is stated rather than measured.
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Enter an A to determine weight anthropometrically.
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Weight should be between 0 Lbs and 750 Lbs.
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Enter Patient's Name:
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Enter Patient's Name to be printed on the report.
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Enter Age Less Than 124 in Years or Months (followed by M) but Not Both
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Wrist Circumference (cm):
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Value should be between 2 and 50cm.; press RETURN to bypass.
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Small
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Medium
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Large
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Frame Size (SMALL,MEDIUM,LARGE) MED//
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Calculation of Ideal Body Weight
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S Spinal Cord Injury
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E Enter Manually
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You Must Choose from the List Above
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Does Patient have an Amputation? NO//
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Amputee Types: (may be multiple, e.g: 2,2,5)
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2 Total Leg (16.1%)
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3 Total Arm (4.9%)
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5 Forearm and Hand (2.3%)
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6 Calf and Foot (5.8%)
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Amputee Types:
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Total Amputee %:
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Total % of amputations should be .5% to 50%
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Select IBW after Amputee Correction:
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Enter a string of types (e.g: 1,1,4); no digit can exceed 6.
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Enter Ideal Body Weight:
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heels and clothes weighing 5# for men and 3# for women.
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Extent of Injury:
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Select:
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Only P or Q are Valid Choices
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Select Ideal Weight (
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No data for your Age Group, the
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Group was used.
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Need Arm & Calf Circumference, at a minimum, to compute weight.
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Calculated Weight:
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Can only calculate knee height for persons aged 60 or older
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Select Ideal Body Weight:
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Do you wish Anthropometric Assessment? NO//
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Enter YES if you have Anthropometric measurements; Otherwise NO
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Triceps Skin Fold (mm):
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Enter value between 1 and 100; outside values should be assessed manually
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Subscapular Skinfold (mm):
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Arm Circumference (cm):
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Enter number between 5 and 100; outside values should be assessed manually
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Calf Circumference (cm):
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Enter value between 10 and 250; outside values should be assessed manually
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Collecting laboratory data ...
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LO=
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HI=
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Energy
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Calculate Energy Needs by:
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3 Enter Manually
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Choose:
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Choose Either 1, 2, or 3
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Enter Energy Requirements (Kcal/day):
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KCAL must be greater than 0
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Is patient confined to bed (Y/N)?
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(Activity Factor =
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Injury/Stress Factors
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Skeletal Trauma
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Major Sepsis
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Severe Burn
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Blunt Trauma
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Trauma w/ Steroid
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Starvation
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Trauma on Ventilator
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Mild Infection
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0-20% BSA Burn
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Moderate Infection
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20-40% BSA Burn
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Long Bone Fracture
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>40% BSA Burn
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Peritonitis
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Stress - Low
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Anabolism
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Cancer
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BEE =
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Select Energy Factor:
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Energy Factor must be Between .7 and 2.5
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Caloric Factors
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Basal Energy
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Ambulatory w/ Weight Maint.
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Malnutrition w/ Mild Sepsis
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Injuries/ Sepsis - Severe
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Burn - Extensive
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Non-Dialysis Renal Failure
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Dialysis
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Dialysis w/ Diabetes
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Enter Kcal/Kg (10-100):
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Kcal/Kg Must be Between 10 and 100
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Enter Caloric Requirements (Kcal/day):
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Enter a value between 1-10000
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Requirements Based On:
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1 Actual Body Weight
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2 Ideal Body Weight
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3 Obese Calculation
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Choose either 1 or 2
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Calculate Fluid Requirements By:
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Adolescent (40-60 ml/kg/day)
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Children (70-110 ml/kg/day)
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Infant (100-150 ml/kg/day)
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2) 100 ml/kg first 10 kg +
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50 ml/kg second 10 kg +
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25 ml/kg remaining kg
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4) 0.5 ml/Kcal (Fluid Overload)
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5) 1500 ml/sq meter
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6) Set Your Own Fluid Level
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7) Omit Calculation
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Choose:
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Choose 1 - 7 Only
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Fluid
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Select Level Between
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Fluid Level is not within range.
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Enter Fluid Requirements (ml/day):
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Level must be between 0-10000 ml/day
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Select Fluid Requirements (ml/day):
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Protein
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Protein Requirements (g/kg)
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Acute Burn, Injury, Trauma
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Convalescent Burn, Injury Trauma
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Malabsorption Syndrome
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Ulcerative Colitis
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Ileocolostomy
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Chronic Liver Disease
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Acute Encephalopathy
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Chronic Renal Failure
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Nephrotic Syndrome
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Burn
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Protein-Sparing
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Enter Protein Level (g/kg)
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Level must be .4 to 4.0
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Enter Protein Requirements (gm/day):
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Enter a value greater than 0 but not more than 400.
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% of KCAL
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Do you want to do a NITROGEN BALANCE? NO//
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Enter Protein Intake (gm/24hr):
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Enter 0-200 grams of protein intake
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Enter Urinary Nitrogen Output (gm/24hr):
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Enter 0-30 gms of Urinary Nitrogen output (24 hr UUN)
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Enter Insensible Nitrogen Output (gm/24hr): 4//
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Insensible Nitrogen output should be between 0-10 grams
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Nitrogen Balance:
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Appearance:
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Enter Physical Appearance of patient; cannot exceed 60 characters.
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Do you wish to FILE this Assessment Y//
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Nutrition Status:
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No Nutrition Assessments on file
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SELECT Assessment Date:
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ADT SEX AGE HGT HGP WGT WGP DWGT UWGT IBW FRM AMP X X X KCAL PRO FLD RC XD BMI BMIP
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TSF TSFP SCA SCAP ACIR ACIRP CCIR CCIRP BFAMA BFAMAP
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Age
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Date of Assessment:
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Height:
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knee hgt
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Weight:
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Weight Taken:
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Weight/Usual Wt:
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Ideal Weight:
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Weight/IBW:
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Ideal weight adjusted for amputation
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Frame Size:
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Body Mass Index:
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Anthropometric Measurements
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Triceps Skinfold (mm)
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Arm Circumference (cm)
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Subscapular Skinfold (mm)
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Bone-free AMA (cm2)
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Calf Circumference (cm)
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Laboratory Data
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Result units
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Ref. range
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No laboratory data available last
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Energy Requirements:
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Kcal:N
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Protein Requirements:
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NPC:N
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Fluid Requirements:
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Nutrition Class:
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Comments
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Entered by:
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NUTRITION ASSESSMENT
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VAF 10-9034
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(Vice SF 509)
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Press RETURN to continue.
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Enter a RETURN to Continue.
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NUTRITION STATUS
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Is this a re-screen (Y/N)?
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Print by CLINICIAN or WARD? WARD//
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Answer with C or W
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I II III IV UNC
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Select one to Display
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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