ORAL NUTRITION SUPPORT (ONS) REFERRAL GUIDELINES PLEASE SCREEN CLIENTS

NATIONAL SCHOOL LUNCH PROGRAM BULLETIN WWWEEDSTATEAKUSTLSCNS CHILD NUTRITION
1 TITLE THE EVOLUTION OF HOME ENTERAL NUTRITION (HEN)
10 MANAGING SEVERE ACUTE MALNUTRITION STUDY SESSION 10 MANAGING

13 NUTRITION AND HYDRATION PREPARATION STORAGE DISPENSING AND CONSUMPTION
13 NUTRITION INFORMATION SYSTEM SESSION 13 NUTRITION INFORMATION SYSTEM
14 EFFECT OF EARLY NUTRITION ON CARCASS AND

DIETITIAN REFERRAL FORM

ORAL NUTRITION SUPPORT (ONS) REFERRAL GUIDELINES PLEASE SCREEN CLIENTS


Oral Nutrition Support (ONS) Referral Guidelines


Please screen clients using the Community MUST to determine the appropriate local management protocol, if referral to the Dietetic Service is indicated (see flow chart below) please complete the attached referral form including:

If a Community MUST is not available please complete the attached referral form and provide, as a minimum:

.

It is essential that this information is provided to effectively triage the referral.


ORAL NUTRITION SUPPORT (ONS) REFERRAL GUIDELINES PLEASE SCREEN CLIENTS

Before referring for ONS consider:


Please attach any other relevant documentation, as appropriate

ORAL NUTRITION SUPPORT Dietetic Referral Form

Please print clearly. Please continue overleaf if required and attach copies of any relevant documents e.g. patient summary, nutrition screening, relevant letters.

Patient’s Name:

D.O.B: |_ _ | _ _ | _ _ _ _|

NHS Number:-

Patient’s Address:



Tel:

Name of person referring:


Dr/ Nurse/ other:____________________

Practice Name & address:


Tel: Fax:

Current Weight: Height: BMI: % weight loss:


Please include weight loss history or usual weight 3-6 months ago:

Reason for referral: if inclusion criteria (BMI<18.5 kg/m2 AND 5-10% unplanned weight loss) not met:

Outcome expectation: for dietetic consultation and follow up

Weight gain Weight stabilisation Other (please state)

Has Food fortification been tried?

How long for?

Have nutrition supplements already been prescribed Yes/No? If yes please provide the following info:

Product(s) prescribed: Frequency advised:

Initiated/advised by: Date Commenced:


Are scripts for above being issued regularly? Yes / No Details:

Relevant social History. Please include contact details of next of kin / carers and any special needs e.g. Communication difficulties, safe guarding issues:


Relevant current and past medical history (if available attach patient summary):

Has the patient consented to this referral? Yes / No If no please explain:


Can the patient attend a clinic? Yes/No

Suitable for visit by lone worker? Yes / No If no please explain:

as the patient any swallowing difficulties? Yes / No

Is the patient known to SALT? Yes / No

Date referred: Signature:

For office use only:

Date received: Dietitian triaged as urgent? Yes / No

Please fax or post completed referral to: Dietetics Department, at either:

Fax: 01670 564007 /Tel: 01670 564006


ORAL NUTRITION SUPPORT (ONS) REFERRAL GUIDELINES PLEASE SCREEN CLIENTS

'Reproduced with kind permission of Cathy Forbes, Advanced Specialist Dietitian, SEPT Community Health Services, Bedfordshire'

ORAL NUTRITION SUPPORT (ONS) REFERRAL GUIDELINES PLEASE SCREEN CLIENTS

Updated March 2016


2015 SENIOR FARMERS’ MARKET NUTRITION PROGRAM (SENIOR PROJECT FRESHMARKET
488B9 §488B—SCHEDULE OF RATINGS–INFECTIOUS DISEASES IMMUNE DISORDERS AND NUTRITIONAL
9 NUTRITION AND BLOOD PLEASE SELECT A TOPIC


Tags: (ons) referral, support, screen, nutrition, (ons), clients, guidelines, referral, please