Run Clinical Swallow Evaluation (Bedside Dysphagia Assessment) — Free

Assessment Context and Readiness

Patient identity and evaluation indication documented critical (required)

Confirm the evaluation note identifies the patient and states the clinical reason for the swallow assessment.

Yes No N/A

Alertness, cooperation, and ability to participate documented critical (required)

Document whether the patient was sufficiently alert and cooperative for valid bedside trials.

Positioning optimized for swallow trials critical (required)

Patient should be positioned upright as safely tolerated before oral trials.

Yes No N/A

Oral intake restrictions or NPO status reviewed

Document whether current diet order, NPO status, aspiration precautions, or relevant restrictions were reviewed before testing.

Yes No N/A

Note (optional)

Oral Motor and Structural Exam

Labial seal and symmetry assessed

Assess lip closure, symmetry, and ability to maintain anterior bolus containment.

Lingual range of motion and strength assessed

Document tongue mobility, coordination, and strength relevant to bolus manipulation.

Jaw, palate, dentition, and oral cavity integrity assessed

Document structural findings that may affect mastication, bolus control, or residue.

Yes No N/A

Note (optional)

Volitional cough and throat clear assessed

Document airway-protective responses relevant to aspiration risk.

Voice quality at baseline documented

Record baseline vocal quality before any PO trials.

Swallow Trials by Consistency

Thin liquid trial completed and tolerated critical (required)

Document response to thin liquid trials, including cough, throat clear, wet voice, or respiratory change.

Mildly thick / nectar-thick liquid trial completed and tolerated

Document response to mildly thick liquid trials if clinically appropriate.

Puree trial completed and tolerated

Document response to puree trials, including oral residue, delayed swallow, cough, or wet vocal quality.

Soft solid / regular solid trial completed and tolerated

Document mastication, bolus formation, oral residue, and airway signs with solids.

Multiple swallows, delayed swallow initiation, or oral residue observed

Select all observed swallow inefficiencies across trial consistencies.

Note (optional)

Aspiration Signs and Airway Protection

Coughing, throat clearing, or choking observed during or after trials critical (required)

Document overt airway compromise during or immediately after PO trials.

Yes No N/A

Wet or gurgly vocal quality after swallow observed critical (required)

Wet vocal quality after swallowing may indicate laryngeal penetration or aspiration.

Yes No N/A

Respiratory change or increased work of breathing observed critical (required)

Document oxygen desaturation, tachypnea, dyspnea, or visible respiratory distress associated with trials.

Yes No N/A

Signs of silent aspiration suspected critical (required)

Use clinical judgment to note concern for aspiration without overt cough or throat clear.

Yes No N/A

Clinical Impression and Recommendations

Need for instrumental swallow study determined critical (required)

Document whether VFSS/MBSS or FEES is recommended based on bedside findings.

Diet and liquid recommendation documented

Record the recommended diet level, liquid consistency, supervision needs, and compensatory strategies.

Patient education and follow-up plan documented

Document education provided, aspiration precautions, and follow-up recommendations.

Yes No N/A

Clinical swallow evaluation completed by SLP

Inspector signature or attestation that the bedside swallow evaluation was completed and documented.

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Run: Clinical Swallow Evaluation (Bedside Dysphagia Assessment)

Assessment Context and Readiness

Oral Motor and Structural Exam

Swallow Trials by Consistency

Aspiration Signs and Airway Protection

Clinical Impression and Recommendations

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