Nutrition Data

Diet recall, meal timing, protein/fiber/fluid, food sensitivities, GI symptoms, appetite, cravings, access, cultural preferences, and supplement use.

Anthropometrics, labs, nutrition-focused physical findings, and readiness.

Recall Method: seven_day
Status: active
Variant: adult
Instrument Version: dietary-pattern-snapshot-v1

Scoring Version: mean-1-7
Status: active
Variant: adult
Item Responses
Instrument Version: gsrs-adult-v1

Not Provided Score

GI symptom burden

Abdominal Pain

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Unanswered

Heartburn

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Unanswered

Acid Regurgitation

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Unanswered

Hunger Pains

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Unanswered

Nausea

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Unanswered

Abdominal Rumbling

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Unanswered

Bloating or Distension

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Burping

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Unanswered

Gas or Flatus

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Unanswered

Constipation

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Diarrhea

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Unanswered

Loose Stools

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Unanswered

Hard Stools

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Unanswered

Urgent Bowel Movement

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Unanswered

Incomplete Evacuation

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Unanswered

Window Days: 7
Red Flag Blood: No
Red Flag Mucus: No
Red Flag Pain: No
Status: active
Variant: adult

Anthropometrics and Nutrition Risk

Height:

Weight:

BMI:

Waist circumference:

Food allergy / intolerance:

Food insecurity or access barrier:

Supplement list reviewed:

Plan and Follow-Up

Focus	Documentation
Nutrition diagnosis	Record PES statement, nutrition priority, evidence, and confidence in diagnosis. Problem: Etiology: Signs / symptoms:
Intervention	Document nutrition prescription, counseling strategy, resources, barriers, and patient agreement. Nutrition intervention: Barriers / supports: Patient agreement:
Monitoring	Set symptoms, intake, labs, anthropometrics, adherence, and follow-up interval. Monitoring indicators: Adherence / response: Follow-up:

Focus

Documentation

Nutrition diagnosis

Record PES statement, nutrition priority, evidence, and confidence in diagnosis.

Problem:

Etiology:

Signs / symptoms:

Intervention

Document nutrition prescription, counseling strategy, resources, barriers, and patient agreement.

Nutrition intervention:

Barriers / supports:

Patient agreement:

Monitoring

Set symptoms, intake, labs, anthropometrics, adherence, and follow-up interval.

Monitoring indicators:

Adherence / response:

Follow-up:

Nutrition Data

Dietary Pattern Snapshot

Details

GSRS

Details

Responses

Bristol Stool Form Scale

Details

Anthropometrics and Nutrition Risk

Plan and Follow-Up

General - Nutrition Assessment for Doctor

Preview