---
title: Nutritional Risk Screening Form Template for Hospital Malnutrition Assessment | Paperform
description: Comprehensive hospital nutrition screening form to assess malnutrition risk, evaluate dietary needs, identify swallowing concerns, and generate dietitian referrals. GDPR & SOC2 compliant.
url: "https://paperform.co/templates/nutritional-risk-screening-malnutrition-assessment"
type: static
generatedAt: "2026-03-28T00:44:39.811Z"
---

[← Back to free form templates](/templates/)    ![Nutritional Risk Screening & Malnutrition Assessment](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/nutritional-risk-screening-malnutrition-assessment.png)
    [Preview](https://_preview.paperform.co/ai-template/nutritional-risk-screening-malnutrition-assessment) [Use this template for free](/create?ai-template=nutritional-risk-screening-malnutrition-assessment)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Dietitian](/templates/role/dietitian/)     About this free form template
### Streamline Nutritional Screening in Your Healthcare Facility

Malnutrition affects up to 50% of hospitalized patients and is linked to longer hospital stays, increased complications, and higher healthcare costs. Early identification through systematic nutritional screening is essential for improving patient outcomes and ensuring appropriate intervention.

This **Nutritional Risk Screening & Malnutrition Assessment** template provides healthcare teams with a structured, evidence-based tool to quickly identify patients at nutritional risk. Whether you're a nurse conducting admission assessments, a dietitian managing referrals, or a hospital administrator standardizing screening protocols, this form helps ensure no at-risk patient falls through the cracks.

#### Why Healthcare Facilities Choose Paperform for Nutritional Screening

**Paperform** is trusted by healthcare providers worldwide to digitize clinical workflows while maintaining the highest security standards. With SOC 2 Type II compliance and GDPR adherence, your patient data remains protected throughout the screening process.

This template replaces cumbersome paper forms and disconnected systems with a streamlined digital assessment that can be completed on any device—at the bedside, in the clinic, or during telehealth consultations. The clean, professional interface ensures accurate data capture while saving valuable clinical time.

#### What This Nutritional Risk Screening Template Includes

Our comprehensive template covers all essential components of nutritional assessment:

 - **Patient demographics and admission information** for proper documentation and tracking
 - **Anthropometric measurements** including height, weight, BMI calculation, and recent weight loss assessment
 - **Nutritional risk screening questions** based on validated screening tools to identify at-risk patients
 - **Malnutrition severity assessment** using standardized criteria for clinical diagnosis
 - **Dietary restrictions and allergies** to ensure safe, appropriate nutrition interventions
 - **Swallowing evaluation screening** to identify dysphagia risk and aspiration concerns
 - **Functional and clinical factors** including appetite, GI symptoms, and medical conditions affecting nutrition
 - **Automatic dietitian referral determination** based on risk factors identified
 - **Priority level assignment** for timely intervention based on urgency

The form uses intelligent conditional logic to show relevant follow-up questions based on initial responses, keeping the assessment efficient while capturing necessary detail for high-risk patients.

#### Who Benefits from This Template

This nutritional screening form is ideal for:

 - **Hospitals and acute care facilities** implementing systematic malnutrition screening protocols
 - **Nurses and nursing assistants** conducting admission nutritional assessments
 - **Registered dietitians** managing referrals and prioritizing patient caseloads
 - **Long-term care facilities** monitoring residents' nutritional status
 - **Rehabilitation centers** assessing patients with complex nutritional needs
 - **Home health agencies** screening patients for nutritional risk in community settings
 - **Healthcare administrators** standardizing nutrition screening across departments

#### Automate Your Clinical Workflows with Stepper

Take your nutritional screening process further by connecting this form to **[Stepper](https://stepper.io)**, Paperform's AI-native workflow automation platform. When a high-risk patient is identified, Stepper can automatically:

 - Create a referral in your dietitian scheduling system
 - Send priority notifications to the nutrition services team
 - Add the patient to a high-risk tracking list in your EMR or spreadsheet
 - Schedule follow-up assessments based on the risk level identified
 - Generate alerts for urgent swallowing concerns requiring speech therapy consult
 - Update care team dashboards with real-time nutritional risk data

By eliminating manual handoffs between screening and intervention, Stepper ensures timely response when patients need it most.

#### Seamless Integration with Your Healthcare Stack

Paperform connects with the tools healthcare teams already use. Send screening results to:

 - **Google Sheets or Airtable** for centralized tracking and reporting
 - **Slack or Microsoft Teams** for instant care team notifications
 - **Your EMR or patient management system** via API or webhook integration
 - **Email** for automated referral notifications to dietitians
 - **Data analytics platforms** to monitor screening compliance and outcomes

These integrations happen automatically with each form submission, reducing documentation burden and ensuring critical information reaches the right people immediately.

#### Evidence-Based Screening in a User-Friendly Format

This template incorporates elements from validated nutritional screening tools while remaining practical for busy clinical environments. The questions are clear and specific, reducing variability in how different staff members conduct screenings.

Healthcare administrators can easily customize the form to align with their facility's specific protocols, add institution-specific questions, or modify risk criteria to match their malnutrition screening guidelines. The intuitive editor requires no coding knowledge—clinical staff can make updates themselves without waiting on IT support.

#### Improve Patient Outcomes While Meeting Regulatory Standards

Systematic nutritional screening is increasingly required by regulatory bodies and quality improvement initiatives. This template helps facilities:

 - **Meet Joint Commission standards** for nutritional screening within 24 hours of admission
 - **Support CMS quality measures** related to malnutrition diagnosis and intervention
 - **Demonstrate compliance** during surveys and audits with complete digital records
 - **Track screening rates** and identify gaps in your nutrition care process
 - **Collect data** for quality improvement initiatives and clinical research

The digital format ensures complete documentation with timestamps, eliminating the gaps common with paper forms that get misplaced or forgotten.

#### Designed for the Realities of Clinical Practice

We understand that nurses and clinical staff are pressed for time. This form is designed to be completed in 5-7 minutes for most patients, with additional detail captured only when risk factors are identified. The mobile-optimized design works perfectly on tablets and phones, allowing bedside completion without returning to a nursing station.

For facilities managing multiple units or locations, Paperform's Agency+ plan allows you to deploy customized versions across different departments while maintaining centralized oversight and reporting.

#### Get Started in Minutes

This template is ready to use immediately or can be customized to match your facility's specific needs. With Paperform's flexible plans, you can start screening patients today without complex implementations or long vendor contracts.

Whether you're launching a new malnutrition screening program or digitizing an existing paper process, this template provides the foundation for better nutritional care. Over 500,000 teams worldwide trust Paperform to handle their mission-critical forms—join healthcare providers who have modernized their clinical workflows while maintaining the security and compliance their patients deserve.

**Start improving nutritional care today with a screening process that's thorough, efficient, and clinically sound.**
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