Medical Conditions If condition has a checkbox and Assign risk based on Risks 134, 341, 347 - Cancer, affects nutritional status a list box, the list box is enabled medical condition 342, 343, 344, 345, 354 - Celiac disease when the user the marked. 346, 347, 348, 349, 348 - Central nervous system disorders checkbox. I list box selection is Carry specific 351, 352, 353, 354, <Condition list box> then required. medical condition to 355, 356, 357, 359, 381 - Dental problems A section of care 360, 361, 362, 381, 361 - Depression Central nervous system plan. 382, 901 362 - Developmental delays, sensory or delays disorders list box values: Carry risks 341-362 interfering with ability to eat Epilepsy (except 352 and 359) 343 - Diabetes mellitus Cerebral (CP) forward to 134 - Failure to thrive Neural tube defects (NTD) subsequent 382 - Fetal Alcohol Syndrome Spina Bifida interviews (including 353 - Food allergies, please list: Myelomeningocele child interview). <Text box> Parkinson’s disease 342 - Gastrointestinal disorder Multiple Sclerosis (MS) <Condition list box> 349 - Genetic and congenital disorders <Condition Gastrointestinal disorder list list box> box values: 345 - Hypertension Gastroesophageal reflux 356 - Hypoglycemia disease (GERD) 351 - Inborn of metabolism Peptic ulcer <Condition list box> Post-bariatric surgery 352 - Infectious disease, affects nutritional status Short bowel syndrome <Condition list box> Inflammatory bowel disease 355 - Lactose intolerance, diagnosed (UC and Chron’s) 341 - Nutrient deficiency disease Liver disease <Condition list box> Pancreatitis 359 - Recent major surgery (including C-sections), Biliary diseases trauma, or burns severe enough to affect nutritional status (describe): <Text box> 901 - Recipient of in the past 6 months Genetic and congenital 346 - Renal disease disorders list box values: <Condition list box> Cleft lip or palate 151 - Small for gestational age Down syndrome 344 - Thyroid disorder Thalassemia 360 - Other, medical conditions severe enough to affect nutritional status <Condition list box>
Medical Conditions 347 - Cancer, affects nutritional status 354 - Celiac disease 348 - Central nervous system disorders <Condition list box> 381 - Dental problems 361 - Depression 362 - Developmental delays, sensory or delays interfering with ability to eat 343 - Diabetes mellitus 134 - Failure to thrive 382 - Fetal Alcohol Syndrome 353 - Food allergies, please list: <Text box> 342 - Gastrointestinal disorder <Condition list box> 349 - Genetic and congenital disorders <Condition list box> 345 - Hypertension 356 - Hypoglycemia 351 - Inborn of metabolism <Condition list box> 352 - Infectious disease, affects nutritional status <Condition list box> 355 - Lactose intolerance, diagnosed 341 - Nutrient deficiency disease <Condition list box> 359 - Recent major surgery (including C-sections), trauma, or burns severe enough to affect nutritional status (describe): <Text box> 901 - Recipient of in the past 6 months 346 - Renal disease <Condition list box> 151 - Small for gestational age 344 - Thyroid disorder 360 - Other, medical conditions severe enough to affect nutritional status <Condition list box> If condition has a checkbox and a list box, the list box is enabled when the user the checkbox. I list box selection is then required. Central nervous system disorders list box values: Epilepsy Cerebral (CP) Neural tube defects (NTD) Spina Bifida Myelomeningocele Parkinson’s disease Multiple Sclerosis (MS) Gastrointestinal disorder list box values: Gastroesophageal reflux disease (GERD) Peptic ulcer Post-bariatric surgery Short bowel syndrome Inflammatory bowel disease (UC and Chron’s) Liver disease Pancreatitis Biliary diseases Genetic and congenital disorders list box values: Cleft lip or palate Down syndrome Thalassemia Assign risk based on medical condition marked. Carry specific medical condition to A section of care plan. Carry risks 341-362 (except 352 and 359) forward to subsequent interviews (including child interview). Risks 134, 341, 342, 343, 344, 345, 346, 347, 348, 349, 351, 352, 353, 354, 355, 356, 357, 359, 360, 361, 362, 381, 382, 901
DFDD%20CS%203c%20Assessment%20-%20Interview%20Screens%20-%20I%20and%20C.docx