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City Facility / Resident / / Company RAI / / Facility Facility Name / Facility ID / / IndustryTerm assistive devices / beverage preference / food allergies / insertion site / reduced food / interventions/services / food/fluid intake goals / facility treatment protocol / food/fluids / food / poor food / adaptive equipment / tube insertion site / individual food preferences / facility-specific guidelines/protocols / food intake / fluid/food restrictions / treatment protocol / care and services / scheduled meal services / / MedicalCondition allergies / headaches / COPD / acute illness / nausea/vomiting / nausea / muscle weakness / persistent fatigue / food allergies / obesity / chronic wounds / renal disease / diarrhea / incurable cancer / severe organ injury / fecal impaction / constipation / infections / cramps / hepatic disease congestive heart failure / Malnutrition / congestive heart failure / pneumonia / upper body muscle weakness / hypertension / cancer / flushing / dysphagia / poor appetite / ESRD / cognitive impairment / diabetes / Pressure ulcers / fever / lethargy / orthostatic hypotension / pain / vomiting / infection / dizziness / depression / immunodeficiency syndrome / dehydration / / MedicalTreatment enteral feeding / nutritional support / antibiotics / chemotherapy / tube feeding / counseling / treatment protocol / / Organization Medicare / US Federal Reserve / / Person Interview Interview / Interview Whether / / Position medical director / as appropriate / charge nurse / director of nursing / Medical Director / physician / head / director of nursing / dietitian / Representative / physician / charge nurse / Surveyor / attending physician / / Product thrive / Coumadin / digoxin / / Technology treatment protocol / specific facility treatment protocol / chemotherapy / facility-specific guidelines/protocols / / SocialTag 
Facility Name: Facility ID: Date: