IDDSI Diet Texture Recommendation Form

A clinical recommendation form for documenting IDDSI food texture and drink thickness levels, replacing legacy diet terminology.

Recommendation Details

• Patient Identifier
  Use a medical record number, chart ID, or other internal identifier. Do not enter SSN or other unnecessary PII.
• Assessment Date
  Date the swallowing assessment or recommendation was made.
• Recommending Clinician
  Name and role of the clinician making the recommendation, such as SLP, dietitian, or physician.
• Reason for Recommendation
  Brief clinical rationale for the IDDSI recommendation, including relevant swallowing safety concerns.

Food Texture Recommendation

• Recommended Food Texture Level
  Select the current recommended IDDSI food level.
• Food Texture Details
  Include specific preparation notes, such as particle size, moisture, or mixing instructions.
• Legacy Term Replaced
  Optional: document the prior terminology being replaced, such as puree, mechanical soft, or chopped.

Drink Thickness Recommendation

• Recommended Drink Thickness Level
  Select the current recommended IDDSI drink level.
• Drink Thickness Notes
  Include preparation, serving, or testing notes needed to maintain the recommended thickness.
• Free Water Protocol Allowed?
  Document whether a free water protocol is permitted under the current care plan.

Implementation and Follow-Up

• Care Team Notified
  Select all parties who have been informed of the recommendation.
• Follow-Up Review Date
  Date for reassessment or review of the diet recommendation.
• Additional Notes
  Use for any implementation notes, tolerance concerns, or communication details relevant to the care plan.