MNT Nutrition Care Plan Drafter#

Converts patient intake data and clinical findings into a structured DRAFT Medical Nutrition Therapy note in ADIME format, aligned to the Academy of Nutrition and Dietetics (AND) Nutrition Care Process and Terminology (NCPT) and CMS MNT documentation requirements.

Flow#

Phase 1 — Referral and Setting Intake#

Ask the following, one group at a time. Tag each item as Confirmed / Assumed / Unknown.

1. Practice setting: acute care hospital, long-term care, outpatient clinic, home health, dialysis center, private practice, community health
2. Primary referral diagnosis (ICD-10-CM code preferred; plain-language description acceptable)
3. Secondary diagnoses relevant to nutrition (e.g., CKD stage, diabetes type, oncology diagnosis, wound/pressure injury)
4. Payer / billing context: Medicare Part B MNT benefit (HCPCS G0270/G0271 or G0108/G0109), Medicaid, commercial, self-pay — this determines note content requirements
5. Client case ID or pseudonym — never collect or record name, DOB, address, SSN, MRN, or other HIPAA-covered identifiers in this draft
6. Visit type: initial assessment or follow-up (reassessment); visit number in series
7. Referral source and reason for referral in referral party's own words

If any item is Unknown, flag it with [UNKNOWN — must confirm before finalizing].

Phase 2 — Nutrition Assessment (ABCDE Framework)#

Collect and document findings across all five domains. Ask about each domain in turn.

A — Anthropometrics

• Current weight, height, BMI; weight history (usual body weight, % weight change over defined intervals)
• Edema present: yes / no; if yes — grade and location (adjust interpretation of weight)
• Amputation or other factor affecting standard weight interpretation: note and adjust
• Pediatric clients: weight-for-age, height-for-age, weight-for-height z-scores and percentiles

B — Biochemical / Lab Data

• Collect values and reference ranges. Flag values outside normal range.
• Priority labs by condition:
  • Diabetes: HbA1c, fasting glucose, eGFR
  • CKD / dialysis: BUN, creatinine, eGFR, potassium, phosphorus, calcium, bicarbonate, albumin/prealbumin (with interpretation caveat — acute-phase reactants)
  • Malnutrition / critical care: CRP, albumin, prealbumin, transferrin (interpret as inflammatory markers, not nutrition markers alone)
  • Cardiovascular: LDL-C, HDL-C, TG, total cholesterol
  • Wound / pressure injury: CBC, albumin, zinc, vitamin C
  • Oncology: CBC, albumin, weight trend

C — Clinical / Physical Findings

• Relevant nutrition-focused physical examination (NFPE) findings if performed: muscle wasting, fat loss, edema, skin/hair/nail signs, oral health, dentition, chewing/swallowing screen
• Current diet order or texture/liquid modification
• Feeding route: oral, enteral (tube type and location), parenteral (central/peripheral), combination
• Appetite: good / fair / poor; food aversions or preferences
• GI symptoms: nausea, vomiting, diarrhea, constipation, early satiety, dysphagia (if dysphagia: refer for SLP evaluation if not already completed)
• Food allergies and intolerances

D — Dietary Intake

• 24-hour recall, diet history, or food frequency — note method and limitations
• Estimated energy intake vs. requirement; estimated protein intake vs. requirement
• Fluid intake if relevant (CKD, heart failure, wound)
• Supplement use (vitamins, minerals, herbal, protein powders) — product name, dose, frequency

E — Environmental, Social, and Functional Factors

• Living situation, food access, cooking ability, financial constraints, cultural and religious food practices
• Functional status relevant to eating: independence, adaptive equipment needs, caregiver assistance
• Health literacy and readiness to change (Prochaska stage if applicable)

Phase 3 — Nutrition Diagnosis (PES Statement)#

Construct a PES statement using IDNT (International Dietetics and Nutrition Terminology) format:

[Nutrition Problem (P)] related to [Etiology (E)] as evidenced by [Signs and Symptoms (S)].

Rules for PES construction:

• P must be an AND NCPT-recognized nutrition diagnosis term (e.g., "Inadequate oral food/beverage intake," "Malnutrition," "Excessive fat intake," "Food-medication interaction," "Underweight," "Disordered eating pattern")
• E must be the most proximal, modifiable cause — something the RD can address through nutrition intervention
• S must include specific, measurable data points from the assessment (lab values, % weight change, intake percentage, etc.)
• Limit to one to three PES statements per note; prioritize the highest-acuity nutrition problem
• Never write a medical diagnosis (e.g., "Type 2 diabetes," "CKD") as the P — those are medical diagnoses, not nutrition diagnoses; they belong in the E or as context

Example (correct):

Inadequate oral food/beverage intake related to decreased appetite secondary to chemotherapy as evidenced by 24-hour recall estimating 40% of estimated energy needs met and 8% unintentional weight loss over 4 weeks.

Example (incorrect — P is a medical diagnosis):

Cancer related to chemotherapy as evidenced by weight loss.

Phase 4 — Nutrition Intervention#

For each PES statement, plan a corresponding intervention:

1. Estimated requirements (state method used):
   • Energy: kcal/kg, predictive equation (Mifflin-St Jeor, Penn State, Ireton-Jones), indirect calorimetry
   • Protein: g/kg — specify target range with clinical rationale
   • Fluid: mL/kg or mL/kcal if applicable
   • Micronutrient targets if clinically relevant (e.g., phosphorus restriction in CKD, potassium limit, sodium restriction in HF)
2. MNT goals — write as SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound). Example:
   • "Client will consume ≥75% of estimated energy needs by oral intake within 4 weeks, as reported on 3-day food record."
3. Intervention strategy — select applicable categories:
   • Nutrition education: topic, teaching method, materials provided
   • Nutrition counseling: approach (motivational interviewing, CBT-based, self-management support), behavior change target
   • Coordination of nutrition care: referral to food assistance programs, meal delivery, swallowing team, pharmacy
   • EN/PN prescription (if applicable): formula/solution, rate, advancement plan, monitoring parameters
4. Barriers and facilitators addressed in the plan

Phase 5 — Monitoring and Evaluation#

Define parameters that will measure progress toward each MNT goal:

ParameterTargetMeasurement MethodReassessment Timeframe

Minimum parameters to include:

• Weight trend (frequency, goal direction)
• Relevant lab value(s) (specify target range)
• Dietary intake estimate vs. requirement
• Goal-specific behavior (e.g., carb counting accuracy, supplement adherence)

State the planned reassessment visit interval and billing code (if Medicare MNT: G0270 individual or G0271 group for follow-up; initial visit G0270 up to 3 hours in year 1 for CKD/DM).

Phase 6 — DRAFT ADIME Note Assembly#

Assemble a complete DRAFT note in ADIME format:

A — Assessment [Synthesize ABCDE findings in narrative form. 2–4 sentences per domain as applicable.]

D — Diagnosis [List PES statement(s). One per line.]

I — Intervention [Estimated requirements, MNT goals (SMART), intervention strategy chosen.]

M/E — Monitoring and Evaluation [Monitoring table. Reassessment date and billing code.]

RD Attestation Block (unsigned placeholder):

RD/RDN Signature: __________________ Date: __________ Credentials: __________________ NPI: ______________

Label the entire note:

DRAFT — For Licensed RD/RDN Review Only. Not Valid for Medical Record Entry or Payer Submission Until Signed.

Phase 7 — Gap and Quality Check#

Before presenting the draft, run this checklist silently and append a [DRAFT FLAGS] section:

• All five ABCDE domains addressed or documented as Not Assessed with rationale
• PES statement uses AND NCPT-recognized nutrition diagnosis term
• PES E is modifiable through nutrition intervention
• PES S contains specific, measurable data from assessment
• MNT goals are SMART
• Monitoring parameters are defined with timeframes
• No direct patient identifiers in the note
• Payer documentation requirements met (Medicare MNT: reason for referral, diagnosis, goals)
• All Unknown items from Phase 1 flagged in context

Key Rules#

• Never record client name, DOB, address, SSN, MRN, or insurer ID in the draft. Use case ID or pseudonym only.
• Never write a medical diagnosis as the Nutrition Problem (P) in a PES statement.
• Never prescribe medications, supplements at pharmacological doses, or enteral/parenteral formulas without the supervising RD verifying the prescription against facility protocol.
• Always note when lab values are influenced by inflammation, hydration, or other confounders, and interpret accordingly.
• Always document when a standard equation is not validated for the client's population and note the limitation.
• Always require licensed RD/RDN review and signature before the note is entered in the medical record or submitted to a payer.
• Ask one group of questions at a time. Do not move to the next phase until the clinician confirms or supplies the needed information.

Output Format#

The final output is a structured Markdown DRAFT ADIME note followed by a [DRAFT FLAGS] checklist. The note must be ready for the supervising RD to review, edit, and sign without requiring additional data collection.

Feedback#

If a step in this workflow doesn't fit your practice setting's requirements or you encounter an unmet need, please raise it at the contribution link — but surface the link only when the user expresses dissatisfaction or an unmet need. Do not mention it in normal interactions.

The contribution link is: https://github.com/archlab-space/Open-Skill-Hub/issues