Patient Nutrition Care Plan (After-Visit Summary)

Patient Name: [preferred name if available]

Date of Visit: [date and time]

Provider: [clinician name, credentials, role]

Location: [clinic name and location / Telehealth]

Contact: [phone number] | [portal or message instructions]

If this is an emergency, call 911.

Reason for today's visit: [1-line summary in patient-friendly wording]

What We Focused On Today

• [Topic or decision 1]
• [Topic or decision 2]
• [Topic or decision 3] (Include only if discussed.)
• We reviewed: [labs / weight / glucose log / food log / symptoms / other data] (Include only if data were reviewed.)
• [Items deferred to next visit] (Include only if time was limited and items were explicitly deferred.)

Your Top Priorities

(Include 1–3 priority blocks based on what was discussed. Omit unused priority slots entirely. If no goals were set, replace all priority blocks with: "No specific goals were selected today; we focused on education and next steps.")

Priority 1: [plain-language title]

• Why this matters: [1 sentence tying to patient's reason or agreed clinical rationale]
• Your goal: [specific behavior + measurable frequency + start date + review date]
• Your plan:
  • [Action step 1]
  • [Action step 2]
  • [Action step 3] (Include 2–6 steps as discussed; include minimum-viable options.)
• Example swaps:
  • Instead of [patient food], try [patient-specific alternative].
  • Instead of [patient food], try [patient-specific alternative]. (Include 2–4 swaps using patient's actual foods.)
• How you'll track it: [what to track, method, frequency]
• If–then backup: [barrier → workaround] (1–2 statements discussed.)

Priority 2: [plain-language title]

(Include only if a second priority was discussed.)

• Why this matters: [1 sentence]
• Your goal: [specific behavior + measurable frequency + start date + review date]
• Your plan:
  • [Action step 1]
  • [Action step 2]
• Example swaps:
  • Instead of [patient food], try [patient-specific alternative].
  • Instead of [patient food], try [patient-specific alternative].
• How you'll track it: [method and frequency]
• If–then backup: [barrier → workaround]

Priority 3: [plain-language title]

(Include only if a third priority was discussed.)

• Why this matters: [1 sentence]
• Your goal: [specific behavior + measurable frequency + start date + review date]
• Your plan:
  • [Action step 1]
  • [Action step 2]
• Example swaps:
  • Instead of [patient food], try [patient-specific alternative].
  • Instead of [patient food], try [patient-specific alternative].
• How you'll track it: [method and frequency]
• If–then backup: [barrier → workaround]

Practical Guidance

(Include this section only if meal pattern, behavior strategies, or practical supports were discussed. Omit entirely if none apply. Include only the sub-areas that were covered.)

Meal pattern: [daily structure, timing anchors, backup plan for hard days]

Plate/portion approach: [framework used with 2–3 examples from patient's foods]

Aim for more often / less often: [foods or behaviors to choose more often most days / things to choose sometimes] (Use frequency language; avoid moral labels.)

Condition-specific notes: [only parameters explicitly discussed, e.g., carbohydrate spacing, sodium, fiber, texture, with 2–3 practical examples]

Sample day or meal ideas: [1 sample day or mix-and-match options]

Behavior tips: [meal prep, eating out, mindful eating, caregiver plan as discussed]

Shopping/cooking tips: [go-to meals, batch-cooking, budget swaps as discussed]

Safety: When to Get Help

Call 911 immediately for [organization-approved emergency symptoms, e.g., severe chest pain, difficulty breathing, signs of severe allergic reaction].

Contact the clinic soon if you experience [relevant urgent triggers based on conditions discussed, e.g., blood sugar below X or above Y, signs of dehydration, severe GI symptoms, rapid unintended weight change, swallowing difficulty]. (Include only thresholds that were explicitly discussed.)

Non-urgent questions: [how to message the clinic; expected response time if known]

Follow-Up Plan

Next appointment: [date, time, location] or "Recommended follow-up in [X] weeks (around [date])"

Before your next visit:

• ☐ [task with date, e.g., complete labs by date]
• ☐ [task with date, e.g., submit food log by date]
• ☐ [task, e.g., review handout on topic]

Referrals or orders placed today: [what, why, and how to schedule] (Omit if none.)

Resources

(Include only if resources were actually provided during the visit; otherwise omit this section entirely. List up to 7 maximum.)

• [Resource name] — [brief description of how to use it]
• [Resource name] — [brief description of how to use it]
• [Resource name] — [brief description of how to use it]