Hospital Patient Malnutrition Survey
The Hospital Patient Malnutrition Survey is a self-administered questionnaire that assesses a patient's risk of malnutrition. T Patients are asked to rate their overall health, energy levels, and ability to perform daily activities. They are also asked about their weight loss, appetite, and food intake.
3 minutes to complete
Eligibility
Patients who are 18 years of age or older and are admitted to the hospital for at least 24 hours are eligible to participate in the survey.
Questions for Hospital Patient Malnutrition Survey
Questions
Have you ever been diagnosed with malnutrition?
- Yes
- No
- Unsure
Are you currently at risk for malnutrition?
Do you have any medical conditions that put you at risk for malnutrition?
- Yes
- No
- Unsure
Do you have difficulty eating or swallowing?
- Yes
- No
- Unsure
Do you have any food allergies or intolerances?
- Yes
- No
- Unsure
Do you have any digestive problems?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to urinate frequently?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to have loose stools or diarrhea?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to vomit frequently?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to have a decreased appetite?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to have difficulty digesting fat?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to have difficulty digesting protein?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to have difficulty digesting carbohydrates?
- Yes
- No
- Unsure
Do you have any medical conditions that cause you to have a decreased absorption of nutrients?
- Yes
- No
- Unsure
Are you on any medications that put you at risk for malnutrition?
Are you pregnant or breastfeeding?
Are you underweight?
Have you lost weight recently without trying?
Do you have a poor appetite?
- Yes
- No
- Unsure
Do you eat fewer than three meals per day?
- Yes
- No
- Unsure
Do you eat mostly unhealthy foods?
- Yes
- No
- Unsure
Assessments Similar to Hospital Patient Malnutrition Survey
- Malnutrition Screening Tool
- Malnutrition Universal Screening Tool
- Patient
- Generated Subjective Global Assessment
- Geriatric Nutritional Risk Index
- Mini Nutritional Assessment
- Nutritional Risk Screening 2002
Here are some FAQs and additional information
on Hospital Patient Malnutrition Survey
What is the purpose of this survey?
The purpose of this survey is to help assess the prevalence of malnutrition among hospital patients and to identify any risk factors that may be associated with it.
How will my information be used?
Your information will be used to help assess the prevalence of malnutrition among hospital patients and to identify any risk factors that may be associated with it. All information collected will be kept confidential.
What are the risks and benefits of participating in this survey?
The risks of participating in this survey are minimal. You may experience some discomfort if you are asked to provide information about sensitive topics, such as your eating habits or your weight. However, the benefits of participating in this survey include helping to improve the quality of care for hospital patients.
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