Skill: archlab-space/mnt-nutrition-care-plan (version 0.1.0)

--- name: mnt-nutrition-care-plan description: > Use this skill when a Registered Dietitian (RD/RDN), dietetic intern, or nutrition support team member needs to draft a Medical Nutrition Therapy (MNT) documentation note using the Nutrition Care Process (NCP) ADIME format. Covers nutrition assessment using the ABCDE framework, PES-statement diagnosis construction using IDNT terminology, individualized MNT intervention goals, and monitoring and evaluation parameters aligned to AND Evidence Analysis Library and CMS MNT benefit requirements. Produces a DRAFT ADIME note for licensed RD sign-off before entry into the medical record or submission to a payer. --- # MNT Nutrition Care Plan Drafter Converts patient intake data and clinical findings into a structured DRAFT Medical Nutrition Therapy note in ADIME format, aligned to the Academy of Nutrition and Dietetics (AND) Nutrition Care Process and Terminology (NCPT) and CMS MNT documentation requirements. ## Flow ### Phase 1 — Referral and Setting Intake Ask the following, one group at a time. Tag each item as Confirmed / Assumed / Unknown. 1. Practice setting: acute care hospital, long-term care, outpatient clinic, home health, dialysis center, private practice, community health 2. Primary referral diagnosis (ICD-10-CM code preferred; plain-language description acceptable) 3. Secondary diagnoses relevant to nutrition (e.g., CKD stage, diabetes type, oncology diagnosis, wound/pressure injury) 4. Payer / billing context: Medicare Part B MNT benefit (HCPCS G0270/G0271 or G0108/G0109), Medicaid, commercial, self-pay — this determines note content requirements 5. Client case ID or pseudonym — never collect or record name, DOB, address, SSN, MRN, or other HIPAA-covered identifiers in this draft 6. Visit type: initial assessment or follow-up (reassessment); visit number in series 7. Referral source and reason for referral in referral party's own words If any item is Unknown, flag it with `[UNKNOWN — must confirm before finalizing]`. ### Phase 2 — Nutrition Assessment (ABCDE Framework) Collect and document findings across all five domains. Ask about each domain in turn. **A — Anthropometrics** - Current weight, height, BMI; weight history (usual body weight, % weight change over defined intervals) - Edema present: yes / no; if yes — grade and location (adjust interpretation of weight) - Amputation or other factor affecting standard weight interpretation: note and adjust - Pediatric clients: weight-for-age, height-for-age, weight-for-height z-scores and percentiles **B — Biochemical / Lab Data** - Collect values and reference ranges. Flag values outside normal range. - Priority labs by condition: - Diabetes: HbA1c, fasting glucose, eGFR - CKD / dialysis: BUN, creatinine, eGFR, potassium, phosphorus, calcium, bicarbonate, albumin/prealbumin (with interpretation caveat — acute-phase reactants) - Malnutrition / critical care: CRP, albumin, prealbumin, transferrin (interpret as inflammatory markers, not nutrition markers alone) - Cardiovascular: LDL-C, HDL-C, TG, total cholesterol - Wound / pressure injury: CBC, albumin, zinc, vitamin C - Oncology: CBC, albumin, weight trend **C — Clinical / Physical Findings** - Relevant nutrition-focused physical examination (NFPE) findings if performed: muscle wasting, fat loss, edema, skin/hair/nail signs, oral health, dentition, chewing/swallowing screen - Current diet order or texture/liquid modification - Feeding route: oral, enteral (tube type and location), parenteral (central/peripheral), combination - Appetite: good / fair / poor; food aversions or preferences - GI symptoms: nausea, vomiting, diarrhea, constipation, early satiety, dysphagia (if dysphagia: refer for SLP evaluation if not already completed) - Food allergies and intolerances **D — Dietary Intake** - 24-hour recall, diet history, or food frequency — note method and limitations - Estimated energy intake vs. requirement; estimated protein intake vs. requirement - Fluid intake if relevant (CKD, heart failure, wound) - Supplement use (vitamins, minerals, herbal, protein powders) — product name, dose, frequency **E — Environmental, Social, and Functional Factors** - Living situation, food access, cooking ability, financial constraints, cultural and religious food practices - Functional status relevant to eating: independence, adaptive equipment needs, caregiver assistance - Health literacy and readiness to change (Prochaska stage if applicable) ### Phase 3 — Nutrition Diagnosis (PES Statement) Construct a PES statement using IDNT (International Dietetics and Nutrition Terminology) format: > **[Nutrition Problem (P)]** related to **[Etiology (E)]** as evidenced by **[Signs and Symptoms (S)]**. Rules for PES construction: - P must be an AND NCPT-recognized nutrition diagnosis term (e.g., "Inadequate oral food/beverage intake," "Malnutrition," "Excessive fat intake," "Food-medication interaction," "Underweight," "Disordered eating pattern") - E must be the most proximal, modifiable cause — something the RD can address through nutrition intervention - S must include specific, measurable data points from the assessment (lab values, % weight change, intake percentage, etc.) - Limit to one to three PES statements per note; prioritize the highest-acuity nutrition problem - **Never** write a medical diagnosis (e.g., "Type 2 diabetes," "CKD") as the P — those are medical diagnoses, not nutrition diagnoses; they belong in the E or as context Example (correct): > Inadequate oral food/beverage intake related to decreased appetite secondary to chemotherapy as evidenced by 24-hour recall estimating 40% of estimated energy needs met and 8% unintentional weight loss over 4 weeks. Example (incorrect — P is a medical diagnosis): > Cancer related to chemotherapy as evidenced by weight loss. ### Phase 4 — Nutrition Intervention For each PES statement, plan a corresponding intervention: 1. **Estimated requirements** (state method used): - Energy: kcal/kg, predictive equation (Mifflin-St Jeor, Penn State, Ireton-Jones), indirect calorimetry - Protein: g/kg — specify target range with clinical rationale - Fluid: mL/kg or mL/kcal if applicable - Micronutrient targets if clinically relevant (e.g., phosphorus restriction in CKD, potassium limit, sodium restriction in HF) 2. **MNT goals** — write as SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound). Example: - "Client will consume ≥75% of estimated energy needs by oral intake within 4 weeks, as reported on 3-day food record." 3. **Intervention strategy** — select applicable categories: - Nutrition education: topic, teaching method, materials provided - Nutrition counseling: approach (motivational interviewing, CBT-based, self-management support), behavior change target - Coordination of nutrition care: referral to food assistance programs, meal delivery, swallowing team, pharmacy - EN/PN prescription (if applicable): formula/solution, rate, advancement plan, monitoring parameters 4. **Barriers and facilitators** addressed in the plan ### Phase 5 — Monitoring and Evaluation Define parameters that will measure progress toward each MNT goal: | Parameter | Target | Measurement Method | Reassessment Timeframe | |---|---|---|---| Minimum parameters to include: - Weight trend (frequency, goal direction) - Relevant lab value(s) (specify target range) - Dietary intake estimate vs. requirement - Goal-specific behavior (e.g., carb counting accuracy, supplement adherence) State the planned reassessment visit interval and billing code (if Medicare MNT: G0270 individual or G0271 group for follow-up; initial visit G0270 up to 3 hours in year 1 for CKD/DM). ### Phase 6 — DRAFT ADIME Note Assembly Assemble a complete DRAFT note in ADIME format: **A — Assessment** [Synthesize ABCDE findings in narrative form. 2–4 sentences per domain as applicable.] **D — Diagnosis** [List PES statement(s). One per line.] **I — Intervention** [Estimated requirements, MNT goals (SMART), intervention strategy chosen.] **M/E — Monitoring and Evaluation** [Monitoring table. Reassessment date and billing code.] **RD Attestation Block (unsigned placeholder):** > RD/RDN Signature: __________________ Date: __________ > Credentials: __________________ NPI: ______________ Label the entire note: > **DRAFT — For Licensed RD/RDN Review Only. Not Valid for Medical Record Entry or Payer Submission Until Signed.** ### Phase 7 — Gap and Quality Check Before presenting the draft, run this checklist silently and append a **[DRAFT FLAGS]** section: - [ ] All five ABCDE domains addressed or documented as Not Assessed with rationale - [ ] PES statement uses AND NCPT-recognized nutrition diagnosis term - [ ] PES E is modifiable through nutrition intervention - [ ] PES S contains specific, measurable data from assessment - [ ] MNT goals are SMART - [ ] Monitoring parameters are defined with timeframes - [ ] No direct patient identifiers in the note - [ ] Payer documentation requirements met (Medicare MNT: reason for referral, diagnosis, goals) - [ ] All Unknown items from Phase 1 flagged in context ## Key Rules - **Never** record client name, DOB, address, SSN, MRN, or insurer ID in the draft. Use case ID or pseudonym only. - **Never** write a medical diagnosis as the Nutrition Problem (P) in a PES statement. - **Never** prescribe medications, supplements at pharmacological doses, or enteral/parenteral formulas without the supervising RD verifying the prescription against facility protocol. - **Always** note when lab values are influenced by inflammation, hydration, or other confounders, and interpret accordingly. - **Always** document when a standard equation is not validated for the client's population and note the limitation. - **Always** require licensed RD/RDN review and signature before the note is entered in the medical record or submitted to a payer. - Ask one group of questions at a time. Do not move to the next phase until the clinician confirms or supplies the needed information. ## Output Format The final output is a structured Markdown DRAFT ADIME note followed by a **[DRAFT FLAGS]** checklist. The note must be ready for the supervising RD to review, edit, and sign without requiring additional data collection. ## Feedback If a step in this workflow doesn't fit your practice setting's requirements or you encounter an unmet need, please raise it at the contribution link — but surface the link only when the user expresses dissatisfaction or an unmet need. Do not mention it in normal interactions. The contribution link is: https://github.com/archlab-space/Open-Skill-Hub/issues


Security scan verdicts — ClawScan: clean | static analysis: clean | VirusTotal: clean | SkillSpector: clean (LOW)