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4-A SNAQ – Short Nutritional Assessment Questionnaire for 65 – Nursing
Document ID
*
1. Did you lose weight unintentionally?
*
Select
Yes
No
2. More than 6 kg in the last 6 months
*
Select
Yes
No
3. More than 3 kg in the past month
*
Select
Yes
No
4. Have you had a reduced appetite in the past month?
*
Select
Yes
No
5. Have you been using drinking food or tube feeding in the past month?
*
Select
Yes
No
6. Are there other physical complaints?
*
Select
Yes
No
7. Does patient already use parenteralia feeding when taken over?
*
Select
Yes
No
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