Nutrition Intake Form

Nutrition Intake Form Template for Philippines

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Key Requirements PROMPT example:

"I need a Nutrition Intake Form for my new sports medicine clinic opening in Manila in January 2025, specifically designed for professional athletes with sections for performance goals and supplement tracking."

Document background

The Nutrition Intake Form is a essential healthcare document used throughout the Philippines for collecting comprehensive dietary and health information from clients seeking nutritional consultation or care. This standardized form, developed in accordance with Philippine healthcare regulations and professional standards, serves as the primary tool for initial nutrition assessment and ongoing care planning. It encompasses detailed sections for gathering personal information, medical history, dietary patterns, and health goals, while maintaining compliance with the Data Privacy Act of 2012 and other relevant healthcare legislation. The form is designed to be adaptable for various healthcare settings, from private nutrition practices to hospital departments, and includes specific provisions for special cases such as pediatric care, sports nutrition, and medical nutrition therapy. Healthcare providers use this Nutrition Intake Form to establish baseline health status, identify nutritional risks, and develop personalized nutrition care plans.

Suggested Sections

1. Personal Information: Basic client details including name, age, gender, contact information, and occupation

2. Medical History: Current medical conditions, medications, allergies, and past medical procedures relevant to nutrition

3. Family Health History: Hereditary conditions and family history of nutrition-related diseases

4. Current Diet Assessment: Typical daily food intake, eating patterns, and dietary preferences

5. Lifestyle Factors: Physical activity level, sleep patterns, stress levels, and daily routine

6. Goals and Concerns: Client's nutritional and health goals, primary concerns, and expectations

7. Consent and Declaration: Client's agreement to provide accurate information and acknowledgment of data privacy terms

Optional Sections

1. Sports Nutrition Requirements: Additional section for athletes or highly active individuals, including training schedule and performance goals

2. Pregnancy/Lactation Details: Specific section for pregnant or nursing mothers, including gestational age and related health factors

3. Pediatric Information: Special section for children, including growth metrics and developmental considerations

4. Eating Disorder History: Detailed section for clients with past or present eating disorders

5. Cultural/Religious Dietary Restrictions: Specific section for detailed cultural or religious dietary requirements and restrictions

Suggested Schedules

1. Food Diary Template: Template for recording detailed daily food intake over a specified period

2. Measurement Record Sheet: Form for tracking anthropometric measurements (weight, height, body composition, etc.)

3. Supplement Record: List of current supplements, vitamins, and minerals being taken

4. Food Allergy/Intolerance List: Detailed documentation of known food allergies, sensitivities, and intolerances

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Wellness and Fitness

Sports and Athletics

Education

Food Service

Corporate Wellness

Public Health

Medical Tourism

Clinical Research

Insurance

Relevant Teams

Clinical Operations

Nutrition Services

Wellness and Prevention

Medical Records

Quality Assurance

Patient Care

Research and Development

Health Information Management

Corporate Wellness

Insurance Processing

Relevant Roles

Registered Nutritionist-Dietitian

Clinical Dietitian

Sports Nutritionist

Public Health Nutritionist

Wellness Coach

Healthcare Administrator

Medical Doctor

Nurse Practitioner

Clinical Research Coordinator

Corporate Wellness Coordinator

School Nutritionist

Food Service Director

Health Insurance Specialist

Medical Records Officer

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Authors

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