Dietitian Consultation Note Template (ADIME)
Standardize your clinical chart notes using the internationally recognized ADIME model. Copy the template below into your practice records for defensible, audit-ready Medical Nutrition Therapy documentation.
Standardized Clinical Note
ADIME Nutrition Care Process Note
A — Assessment (Anthropometric, Biochemical, Clinical & Dietary Data)
- • Anthropometrics: Height: 168 cm | Weight: 78.4 kg | BMI: 27.8 (Overweight) | Waist: 88 cm
- • Biochemical Labs: Fasting Blood Glucose: 118 mg/dL | HbA1c: 6.2% | Total Cholesterol: 215 mg/dL | TSH: 2.8 uIU/mL
- • Clinical / Meds: Metformin 500mg OD. Reports post-prandial lethargy and mild evening bloating.
- • Dietary Baseline: Estimated intake ~2,200 kcal/d with 68% refined carbohydrates (frequent parathas, refined flours, sweet chai) and sub-optimal protein (approx. 38g/day vs ~65g requirement).
D — Diagnosis (PES Statement)
Problem (P): Excessive carbohydrate intake (NI-5.8.2)
related to (E): lack of prior nutrition education regarding refined vs complex carbohydrates and frequent consumption of sweetened beverages
as evidenced by (S): 24-hr dietary recall indicating 68% of calories from refined carbs, elevated HbA1c of 6.2%, and post-prandial fatigue.
I — Intervention (Food Delivery, Education & Counseling)
• Diet Prescription: Prescribed a 1,600 kcal/day cardioprotective, low-glycemic meal plan (Protein 80g / 20%, Carbs 180g / 45%, Fats 60g / 35%).
• Food Adjustments: Swapped refined maida flatbreads for 100% whole grain wheat/jowar; added 1 katori low-fat paneer/sprouts to lunch and dinner to balance glycemic spikes.
• Patient Education: Educated on the "Plate Method" (1/2 non-starchy vegetables, 1/4 lean protein, 1/4 high-fiber carbohydrates); reviewed hidden sugars in evening chai.
M & E — Monitoring & Evaluation
• 1-Week Target: Track daily food logs via client app; assess tolerance to increased fiber; verify hydration intake (>2.5 L/day).
• 4-Week Target: Target 1.5–2.0 kg gradual weight reduction; repeat fasting blood sugar check; evaluate reduction in afternoon fatigue.
• Follow-Up Appointment: Scheduled for [Date] at [Time] via video consultation.
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