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Run: IDDSI Diet Texture Recommendation Form

This IDDSI Diet Texture Recommendation Form documents the recommended food texture and drink thickness levels, plus the reason, follow-up, and care-team hand...

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Recommendation Details

Patient Identifier (required)

Use a medical record number, chart ID, or other internal identifier. Do not enter SSN or other unnecessary PII.

Assessment Date (required)

Date the swallowing assessment or recommendation was made.

Recommending Clinician (required)

Name and role of the clinician making the recommendation, such as SLP, dietitian, or physician.

Reason for Recommendation (required)

Brief clinical rationale for the IDDSI recommendation, including relevant swallowing safety concerns.

Food Texture Recommendation

Recommended Food Texture Level (required)

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 (required)

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.

Yes No N/A

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.

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