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, 362, 381, 382, 362 - Developmental delays, sensory or motor Central nervous system plan. 901, 902 delays interfering with ability to eat disorders list box values: risks 341-362 343 - Diabetes mellitus Epilepsy (except 352 and 359) 134 - Failure to thrive Cerebral palsy (CP) forward to 382 - Fetal Alcohol Syndrome Neural tube defects (NTD) subsequent 353 - Food allergies, please list: Spina Bifida interviews (including <Text box> Myelomeningocele child interview). 342 - Gastrointestinal disorder Parkinson’s disease <Condition list box> Multiple Sclerosis (MS) 349 - Genetic and congenital disorders <Condition list box> Gastrointestinal disorder list 345 - Hypertension box values: 356 - Hypoglycemia Gastroesophageal reflux 351 - Inborn error of metabolism disease (GERD) <Condition list box> Peptic ulcer 352 - Infectious disease, affects nutritional status Post-bariatric surgery <Condition list box> Short bowel syndrome 355 - Lactose intolerance, diagnosed Inflammatory bowel disease 341 - Nutrient deficiency disease (UC and Chron’s) <Condition list box> disease 359 - Recent major surgery (including C-sections), Pancreatitis trauma, or burns severe enough to affect nutritional Biliary tract diseases status <Text box> 901 - Recipient of abuse in the past 6 months Genetic and congenital 346 - Renal disease disorders list box values: <Condition list box> lip or palate 151 - Small for gestational age Down syndrome 344 - Thyroid disorder Thalassemia major 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 362 - Developmental delays, sensory or motor 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 error 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 <Text box> 901 - Recipient of abuse 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 palsy (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) disease Pancreatitis Biliary tract diseases Genetic and congenital disorders list box values: lip or palate Down syndrome Thalassemia major Assign risk based on medical condition marked. Carry specific medical condition to A section of care plan. 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, 362, 381, 382, 901, 902
DFDD%20CS%203c%20Assessment%20-%20Interview%20Screens%20-%20I%20and%20C.docx