Clinical Documentation

Mini Nutritional Assessment -- Screening Questionnaire

Answer every question.

Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?

0 = severe decrease in food intake
1 = moderate decrease in food intake
2 = no decrease in food intake

Weight loss during the last 3 months

0 = weight loss greater than 3 kg (6.6 lbs)
1 = does not know
2 = weight loss between 1 and 3 kg (2.2 and 6.6 lbs)
3 = no weight loss

Mobility

0 = bed or chair bound
1 = able to get out of bed / chair but does not go out
2 = goes out

Has suffered psychological stress or acute disease in the past 3 months?

0 = yes
2 = no

Neuropsychological problems

0 = severe dementia or depression
1 = mild dementia
2 = no psychological problems

Body Mass Index (BMI) (weight in kg) / (height in m squared)

0 = BMI less than 19
1 = BMI 19 to less than 21
2 = BMI 21 to less than 23
3 = BMI 23 or greater

If BMI is not available, use calf circumference in cm

0 = CC less than 31
3 = CC 31 or greater