ADIME NOTE

Patient: [Name]
Date of birth: [Date]
Date of visit: [Date]
Visit: [Initial or follow-up; in person, phone, or video]
Referred by: [Name, and reason for referral]
Dietitian: [Name, credentials]

ASSESSMENT
Food and nutrition history: [Usual intake or 24-hour recall, meal pattern, beverages, supplements, food access]
Anthropometrics: [Height, weight, BMI, usual weight, and weight change over time]
Biochemical data and tests: [Relevant labs with dates and units, and medical tests]
Nutrition-focused physical findings: [Muscle and fat loss, edema, oral health, swallowing, appetite, GI symptoms]
Client history: [Diagnoses, medications that affect nutrition, living situation, activity]
Estimated needs: [Energy, protein, and fluid, with the method or equation used]

DIAGNOSIS
PES statement 1: [Problem related to etiology as evidenced by signs and symptoms]
PES statement 2: [Problem related to etiology as evidenced by signs and symptoms]

INTERVENTION
Nutrition prescription: [Energy, protein, fluid, and any nutrient, texture, or meal pattern targets]
Food and nutrient delivery: [Diet order, meals and snacks, supplements]
Education: [Topics covered, materials given, understanding shown]
Counseling: [Approach used, and the goals the patient chose]
Coordination of care: [Referrals, and who was updated on the plan]

MONITORING AND EVALUATION
Indicators: [What will be tracked, linked to each PES sign or symptom]
Criteria: [Target for each indicator, with a time frame]
Follow-up: [When, how, and with whom]

Signed: [Dietitian name, credentials, date and time]