Free Form 02AG025E (SUOA-S-74) Instructions - Oklahoma

Dietary Consultant's Report Purpose of Form

02AG025E (SUOA-S-74)

Form 02AG025E is used by the consulting registered dietitian (RD) to document the time spent at the site, in-service training provided to staff, nutrition education provided to participants, and recommendations to improve service delivery. The RD may also use this tool to document those participants consulted regarding their nutrition risk based on the Determine Your Nutritional Risk screening tool. Instructions Form SUOA-S-74 is completed after each site visit by the licensed RD. Reports are submitted to the project administration as indicated in the contract, at least monthly. A report from the RD is submitted for each new site kitchen and serving facilities as soon as the site is selected and prior to selecting and locating project purchased equipment. This report includes an evaluation of the proposed kitchen plan and equipment requested. Plans for activating a new site operation are developed by the project director and RD indicating in-service training for staff prior to opening. Routing Project administration submits a copy of each report monthly to Oklahoma Department of Human Services (OKDHS), Aging Services Division.

OKDHS revised 8-8-2003

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