Advanced Medical Dietetics Tool

Professional nutrition assessment and planning

Patient Information

Patient ID:

Full Name:

Gender:

Age:

Ethnicity (for BMI classification):

Caucasian Asian African Hispanic Middle Eastern Other

Pregnancy Status (if applicable):

Pediatric Information

Birth Weight (kg):

Gestational Age at Birth (weeks):

Previous Growth Percentile:

Anthropometric Measurements

Height (cm):

Weight (kg):

Recent Weight Change (kg):

Over what time period (weeks)?

Edema Status:

Waist Circumference (cm):

Hip Circumference (cm):

Body Fat % (optional):

Clinical Parameters

Activity Level:

Nutrition Goal:

Medical History

Medical Conditions (comma separated):

Current Medications (comma separated):

Food Allergies/Intolerances (comma separated):

Recent Lab Values (optional):

Functional Status:

Core Metrics

Body Mass Index (BMI):

BMI Category:

Basal Metabolic Rate (BMR):

Total Daily Energy Expenditure (TDEE):

Advanced Metrics

Waist-Hip Ratio (WHR):

Fat-Free Mass (FFM):

Ideal Body Weight:

Adjusted Body Weight (if obese):

Clinical Recommendations

Protein Intake:

Fluid Intake:

Macronutrient Distribution:

Condition-Specific Adjustments:

Clinical Interpretation

Please calculate results to view interpretation.

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