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Run: Resident Weight Variance Tracking Log

Track resident weights month by month, calculate 30- and 180-day variance, and flag clinically significant loss for dietitian review and care plan follow-up.

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Inspection Details

Facility name critical (required)

Unit or neighborhood

Inspection month critical (required)

Enter the month being reviewed for resident weight variance.

Inspector name and title critical (required)

Resident Weight Record

Resident identifier critical (required)

Use resident ID or chart number; avoid full name if not required by policy.

Current weight critical (required)

Weight date critical (required)

Weight 30 days ago critical (required)

Weight 180 days ago critical (required)

Variance Calculation and Threshold Review

Percent weight change over 30 days critical (required)

Document the calculated percentage change from the weight 30 days ago to the current weight.

Percent weight change over 180 days critical (required)

Document the calculated percentage change from the weight 180 days ago to the current weight.

5% weight loss in 30 days threshold met critical (required)

Mark Yes if the resident has lost 5% or more of body weight in the last 30 days.

Yes No N/A

10% weight loss in 180 days threshold met critical (required)

Mark Yes if the resident has lost 10% or more of body weight in the last 180 days.

Yes No N/A

Clinical Review and Follow-Up

Dietitian review completed critical (required)

Confirm the resident was referred to or reviewed by the dietitian when a threshold was met.

Yes No N/A

Care plan updated for weight loss intervention critical (required)

Confirm care plan interventions were initiated or revised based on the weight variance findings.

Yes No N/A

Contributing factors documented

Note (optional)

Disposition and Sign-Off

Resident requires ongoing monitoring critical (required)

Indicate whether the resident should remain on enhanced weight monitoring or follow-up review.

Yes No N/A

Corrective actions and follow-up notes

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