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Therapeutic Diet Manual April 2018
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NEW YORK STATE, DEPARTMENT OF CORRECTIONS AND COMMUNITY SUPERVISION. OFFICE OF NUTRITIONAL SERVICES,DIRECTIVE 4311, Directive 4311 Therapeutic Diet Manual establishes this manual as the prevailing. document in the provision of therapeutic diets within the New York State Department of. Correctional and Community Supervision The Department provides therapeutic diets upon. written request by an approved health care provider The purpose of the Therapeutic Diet. Manual is to, establish and promulgate the administrative and operation procedures. governing the provision of therapeutic diets, provide guidance and direction to the health care providers and food. service personnel in requesting and providing therapeutic diets. NYS DOCCS Therapeutic Diet Manual April 2018 Page 1. TABLE OF CONTENTS,POLICIES AND PROCEDURES,Nutrition Professional Staff 3.
Therapeutic Diet Requests 4, Algorithm for Processing Therapeutic Diet Requests 5. Therapeutic Diet Request Review and Renewal 6,Therapeutic Diet Meal Attendance 7. Therapeutic Diet Change or Cancellation 8,NYS DOCCS Statewide Menus 9. Therapeutic Diet Summary 10,THERAPEUTIC DIETS,MODIFIED TEXTURE CONSISTENCY. Clear Liquid 11,Full Liquid 12,MODIFIED CONTENT CONTROLLED A B DIETS.
Enhanced Fiber 14,Restricted Fat Low Cholesterol 15. Restricted Sodium 16,Gastro Esophageal Reflux Disease GERD 17. Pregnancy and Lactation 18,Diet for Infants Nine Months of Age and Older 19. Food List for Infants Nine Months and Older 20,Limited Carbohydrates 21. MODIFIED CONTENT PRO 1 2 3 DIETS,Controlled Protein 22.
OTHER CONSIDERATIONS,Food Allergies Intolerances Aversions 23. Gluten Free Diet 24,Lactose Intolerance vs Milk Allergy 25. Medical Nutrition Supplements Diet Education Materials References 26. NYS DOCCS Therapeutic Diet Manual April 2018 Page 2. PROFESSIONAL NUTRITION STAFF, The New York State Department of Corrections and Community Supervision employs. Nutritional Services Administrator 1 items dietitians and dietitian technicians to provide. professional skills in the delivery of nutritional care to the prison population. Nutritional Services Administrator 1 NSA1 regional dietitians. Under the general direction of the Nutritional Services Assistant Director the. regional dietitian is responsible for the Central Office monitoring and. administration of therapeutic diet programs in the assigned region The regional. dietitian functions as a liaison between Food Service and Health Services at the. facility level Regular site visits are conducted and outcomes are addressed with. facility administrators The regional dietitian assists with statewide nutrition policy. and procedure development diet manual revision and other administrative tasks. The regional dietitian also oversees medical nutrition therapy at the regional. medical units RMU at Bedford Hills Fishkill and Wende Correctional Facilities. as well as Walsh at Mohawk Correctional Facility,Dietitians Dietitian Technicians. Under the direction of the NSA1 the dietitians and the dietitian technicians are. the on site nutrition support personnel for the regional medical units These. positions provide administrative support to the NSA1 monitor diet meal tray. accuracy and train food service staff in basic therapeutic diet requirements. Consultant Dietitians, Medical Nutrition Therapy is provided to the Department of Correctional and.
Community Supervision dialysis units and Coxsackie RMU by consultant. dietitians on a contractual basis, NYS DOCCS Therapeutic Diet Manual April 2018 Page 3. THERAPEUTIC DIET REQUESTS, Therapeutic diets are provided with a written prescription by an authorized health care provider. in accordance with the following procedure, 1 Therapeutic diets including allergy diets shall be prescribed by an authorized health. care provider For the purpose of this manual an authorized health care provider is. defined as a physician dentist physician s assistant nurse practitioner registered. 2 The Therapeutic Diet Request Form and Attendance Agreement form 3273 is the. communication tool used to request the prescribed therapeutic diet including allergy. diets from the food service department and to apprise the inmate patient of the. mandatory meal attendance policy, The Therapeutic Diet Request Form and Attendance Agreement comprise one. document and may be ordered from the Elmira Correctional Facility Industries. print shop Form 3273, The form must be completed in full and legibly signed by an authorized health.
care provider the inmate and a witness, The original remains in the inmate s health record under miscellaneous or in. the RMU the Dietary section, The duplicate is forwarded to the food service supervisor. 3 The prescribed therapeutic diet shall be appropriate for the documented diagnosis in the. inmate s health record, 4 The diets listed on the therapeutic diet request form are routinely available from the food. service department Requests for diets that are not listed on this form require the prior. approval of a regional dietitian including food allergies Diet requests that are not in. compliance will be returned to the health care provider. 5 Inmate requests for religious diets foods shall not be prescribed by the health. care provider For additional information regarding policy on religious food requests. see Directive 4202 Religious Programs Practices and Directive 4310 Food. Services Operations Manual, 6 The food service department will begin the diet by the noon meal of the day after receipt. of the completed and signed diet request form, 7 Diet requests of an urgent nature and called to the food service department will be.
initiated as soon as possible The telephone request must be followed by a signed diet. request form within 72 hours, NYS DOCCS Therapeutic Diet Manual April 2018 Page 4. ALGORITHM FOR PROCESSING THERAPEUTIC DIET REQUESTS. IN THE GENERAL POPULATION SETTING,STANDARD NON STANDARD. Requests for only Any write in diet on,the diets listed on Form 3273. Health Services staff to contact,the regional dietitian to determine. if the requested non standard diet,order is available.
The regional dietitian will send a,non standard,written response to Health. Services and instructions to Food,Review the attendance. agreement with the,inmate Have inmate sign,it and staff witness sign it. Non Standard diet requests that,are not available no. communication to food service,File original in the.
miscellaneous section of,the medical record,Dietary section in RMU. SEND YELLOW COPY,TO FOOD SERVICE, NYS DOCCS Therapeutic Diet Manual April 2018 Page 5. THERAPEUTIC DIET REQUEST REVIEW AND RENEWAL, Requests for therapeutic diets shall be reviewed and approved as current at least monthly by. an authorized health care provider, 1 A current list of the therapeutic diet requests shall be maintained by food service. 2 Adjustments to the food service diet list are made based on the following criteria. new or changed diet requests received, diet cancellation by the health care provider received.
transfer parole or death of the inmate, 3 At least monthly an authorized health care provider shall review and sign the updated. therapeutic diet list This signifies that each diet request is current and remains appropriate. for the medical condition, The updated and signed diet list shall be returned to the food service. NYS DOCCS Therapeutic Diet Manual April 2018 Page 6. THERAPEUTIC DIET MEAL ATTENDANCE, Meal attendance is mandatory for inmates receiving a therapeutic diet. 1 An authorized health care provider prescribes a therapeutic diet using the Therapeutic. Diet Request Form and Attendance Agreement Form 3273. 2 The inmate shall sign the attendance agreement portion of the Therapeutic Diet Request. Form and Attendance Agreement that documents understanding of the meal attendance. requirement and intention to comply The meal attendance agreement is obtained by. the health care provider at the time the therapeutic diet is prescribed. 3 The food service supervisor shall develop a therapeutic diet tracking form for recording. attendance at mealtime The forms must be reviewed weekly by the food service. supervisor for compliance These forms must be kept for three years The attendance. form shall contain the following information,Date of monitoring period. Signature or initials of person recording attendance for each meal. Grid for checking each meal for 7 days, 4 Missing greater than three 3 diet meals per week is a violation of the attendance policy.
After verifying the attendance record the food service supervisor shall advise facility. health services in writing of the attendance violation Food service or security staff may. take disciplinary action, 5 Upon notification of violation of the attendance policy the health care provider may. counsel the inmate or cancel the diet Discontinuance of the therapeutic meals by a. health care provider due to non compliance shall be documented in the medical record. 6 Sharing swapping of food is a violation of the therapeutic diet attendance policy. 7 An inmate may request to be placed back on the therapeutic diet meals program through. the facility s sick call procedure A new Therapeutic Diet Request Form and Attendance. Agreement must be completed signed and sent to food service A pattern of multiple. violations of the attendance policy will result in disciplinary action. NYS DOCCS Therapeutic Diet Manual April 2018 Page 7. THERAPEUTIC DIET CHANGE OR CANCELLATION, Therapeutic diet requests may be changed or canceled. 1 A therapeutic diet request is changed when a medical condition changes or a new. diagnosis is made, A The health care provider shall advise the inmate that a diet change is indicated This. interaction is documented in the medical record, B A new Therapeutic Diet Request Form and Attendance Agreement Form 3273 shall. be completed and sent to the food service supervisor The new diet request should. reflect the complete diet prescription not just the changed portion The most recent. diet request form supersedes all others, 2 A therapeutic diet request is canceled under the following circumstances.
A An inmate may refuse participation in the therapeutic diet program The health care. provider shall advise the inmate of the negative health consequences that may result. from diet non compliance To adequately document the interaction a Refusal of. Medical Examination and or Treatment Form form 3195 shall be completed A. Therapeutic Diet Request and Attendance Agreement form marked diet. cancellation shall be completed signed by an authorized health care provider and. sent to the food service supervisor The inmate s signature is not required. B A therapeutic diet is no longer indicated due to a change in medical condition. supporting documentation must be in the medical record A Therapeutic Diet. Request and Attendance Agreement form marked diet cancellation shall be. completed signed by an authorized health care provider and sent to the food service. supervisor The inmate s signature is not required, C If the inmate fails to comply with the signed therapeutic diet attendance agreement. participation in the diet meals program may be canceled by a health care provider. A Therapeutic Diet Request Form and Attendance Agreement marked diet. cancellation shall be completed signed by an authorized health care provider and. sent to the food service supervisor The inmate s signature is not required. NYS DOCCS Therapeutic Diet Manual April 2018 Page 8. NYS DOCCS STATEWIDE MENUS,DISCUSSION, The menus are designed to maintain or improve the nutritional health of inmates while. incarcerated, 1 The General Confinement Menu is a cycle menu and is revised as needed This menu. offers an average of 2 800 calories and 90 grams protein per day. 2 The Adolescent Menu is a cycle menu and is revised as needed This menu offers an. average of 3 000 calories and 110 grams protein, 3 The Shock Incarceration Menu is a cycle menu and is revised as needed This menu. offers an average of 3 800 calories and 125 grams protein. 4 Modified Menus are prepared according to the diet requested The therapeutic diets. are patterned after the general confinement menu utilizing as many of the same food. items as possible Food items are changed when necessary for therapeutic or. production purposes The Modified Menu is organized into menu categories entitled. Controlled A B PRO 1A B PRO 2A B and PRO 3A B, 5 Double portions of food is not considered a therapeutic diet and is not available Refer.
to the Health Services Policy 1 46 on medical nutrition supplements for additional. calories and protein between meals Contact the regional dietitian for assistance with. determining calorie and protein needs, 6 Religious Menus are developed jointly by the Office of Nutritional Services and the. Division of Ministerial Family and Volunteer Services Inmate requests for religious. diets should be directed to the facility s ministerial services The Therapeutic Diet. Request Form and Attendance Agreement 3273 is not used to order religious diets. To maintain religious integrity Religious Menus must be strictly followed A request for. the combination of a therapeutic and religious diet is addressed by Central Office. Nutritional Services to assure the needs in both areas are reasonably accommodated. Alternative and Religious Menus are also discussed in Directive 4202 and Directive. NYS DOCCS Therapeutic Diet Manual April 2018 Page 9. THERAPEUTIC DIET SUMMARY,MODIFIED TEXTURE CONSISTENCY. Clear Liquid Fluids and foods that are clear liquid at body temperature. Pre op or diagnostic GI procedures post op for gradual transition to a normal diet. provide rest to GI tract nausea vomiting or inflammatory diseases of GI tract. An expiration date must be included with the diet request. Full Liquid Nutrient dense liquids or semi liquids at room temperature. Acute illness in transition to solids chewing significantly impaired. An expiration date must be included with the diet request. Soft Moist texture easy to chew and swallow, Sore mouth dental problems impaired GI tract dysphagia. An expiration date must be included with the diet request. Pureed diets are available at RMUs only consult the regional dietitian. MODIFIED CONTENT, Controlled A Enhanced fiber restricted sodium fat cholesterol. Approximately 2 300 calories 2 400 mg sodium 215 mg cholesterol 33 g dietary fiber. Constipation cardiovascular disease hypertension gastroesophageal reflux. Controlled B Same as Controlled A plus limited carbohydrates. Approximately 2 200 calories, Constipation cardiovascular disease hypertension gastroesophageal reflux and.
blood glucose control,Pro 1A Restricted protein and sodium. Approximately 2 100 calories 65 g protein 2 400 mg sodium. Short term treatment of symptomatic encephalopathy. Pro 2A Restricted protein sodium potassium and phosphorus. Approximately 2 100 calories 68 g protein 2 400 mg sodium 3 000 mg potassium. 1 000 mg phosphorus, Acute Renal Failure End Stage Renal Failure ESRF Nephrotic Syndrome. Pro 3A Moderate protein reduced sodium potassium phosphorus. Approximately 2 250 calories 91 g protein 2 400 mg sodium 4 000 mg potassium. 1 000 mg phosphorus, End stage renal disease and receiving hemodialysis or peritoneal dialysis. Protein controlled diets with comorbidity of blood glucose imbalance order the B version. for limited carbohydrates These diets offer an option for an evening snack. FOOD ALLERGIES, Confirmed food allergies require consultation with the regional dietitian in order for the proper. meal plan to be arranged with food service, NYS DOCCS Therapeutic Diet Manual April 2018 Page 10.
CLEAR LIQUID DIET, The objective of the diet is to provide very low residue liquids that are easily absorbed. by the gastrointestinal tract,DISCUSSION, The clear liquid diet consists of fluids and foods that are clear liquid at body temperature This. diet can be used for pre operative or diagnostic procedures of the bowel and colon post. operatively and to provide comfort and or rest to the gastrointestinal tract for disturbances such. as nausea vomiting or inflammatory diseases of the bowel Because of the high sugar content. a clear liquid diet is not recommended for treatment of diarrhea. All clear liquid diet requests must have an expiration date The meal plan for the clear. liquid diet is nutritionally inadequate and should not be prescribed for longer than three days. without adding a nutrition supplement Consult with the regional dietitian for information. regarding medical nutrition supplements formulated for clear liquid diets. DIETARY PROVISIONS PREPARATION INFORMATION,1 Foods may not contain any particles or pulp. 2 Allow water tea black coffee apple juice grape juice fruit flavored beverages bouillon. plain gelatin desserts frozen juice bars and sugar are allowed. 3 At least two quarts or eight cups of clear liquid should be given daily. Milk and dairy products are NOT clear liquids and may not be given. NOTE Some diagnostic procedures require caffeine restrictions Other procedures restrict. red and purple liquids such as cranberry and grape juice gelatin or frozen juice bars. Nutritional Services personnel should make appropriate substitutions when advised by the. regional dietitian or health services personnel,SAMPLE CLEAR LIQUID MENU. BREAKFAST LUNCH AND DINNER,2 4oz Apple Juice 2 4oz Apple Juice.
1 8oz Broth prepared 1 8oz Bouillon prepared,1 cup Flavored Gelatin 1 cup Flavored Gelatin. 1 Frozen Juice Bar if available 1 8oz Fruit flavored beverage. 1 8oz Coffee 1 Frozen Juice Bar,2 Sugar packets 1 Tea bag and 8oz hot water. 2 Sugar packets, NYS DOCCS Therapeutic Diet Manual April 2018 Page 11. FULL LIQUID DIET, The objective of the diet is to provide nutrient dense liquids for individuals who cannot. tolerate solid food,DISCUSSION, The full liquid diet consists of foods that are liquid or semi liquid at room temperature This diet.
is indicated when solid food is not tolerated during acute illness or when chewing ability is. impaired The meal plan for the full liquid diet is nutritionally inadequate and should not be. prescribed for longer than five days without adding a medical nutrition supplement Consult. with the regional dietitian as to the most appropriate formula This diet request must have an. expiration date,DIETARY PROVISIONS PREPARATION INFORMATION. 1 At least two quarts eight cups of liquid should be given daily. 2 Allow all foods from the clear liquid diet, 3 Also allow milk milk drinks plain puddings plain ice cream sherbet frozen juice bar. yogurt prepared bouillon,SAMPLE FULL LIQUID MEALS,BREAKFAST LUNCH AND DINNER. 2 4oz Apple Juice 2 4oz Apple Juice,1 8oz Bouillon prepared 1 8oz Bouillon prepared. 1 cup Flavored Gelatin 1 cup Flavored Gelatin, 1 4oz Yogurt no fruit 1 cup Pudding chocolate or vanilla.
2 8oz White Milk 1 cup Ice Cream Sherbet or 1 Frozen Juice Bar. 1 8oz Coffee 2 8oz White Milk,2 Sugar packets 1 Tea Bag and 8 oz hot water. 2 Sugar packets, NYS DOCCS Therapeutic Diet Manual April 2018 Page 12. The objective of the diet is to provide foods of a moist texture that are easy to chew and. DISCUSSION, This diet is indicated for individuals with sore mouth dental problems impaired gastrointestinal. tract or dysphagia This diet is often needed for short periods of time therefore an expiration. date is required with the diet request,DIETARY PROVISIONS PREPARATION INFORMATION. Either the general or modified menu can be used for soft diets with the following changes. BREAKAST No fresh fruit except bananas no bagels or toast. LUNCH DINNER, ENTREES Grind all hot meats or chop very fine remove casing from sausage hot dogs.
Substitute items that cannot be ground breaded fish burrito Jamaican beef patty pizza. grilled cheese, STARCHES No potato skins potato salad or macaroni salad. VEGETABLES No raw vegetables,BREADS All are allowed. DESSERTS FRUIT No fresh fruit except bananas no cookies. CONDIMENTS All are allowed,BEVERAGES All are allowed. Provide substitutions with foods allowed Be sure meats are kept moist. NYS DOCCS Therapeutic Diet Manual April 2018 Page 13. ENHANCED FIBER DIET, The objective of the Enhanced Fiber diet is to increase the size and bulk of the stool in. order to promote normal laxation in the individual. DISCUSSION, This diet is generally used in the prevention and or treatment of constipation and non.
inflammatory diseases of the colon such as diverticulosis and spastic colon. Research has also shown a positive relationship between dietary fiber and weight control. stabilization of blood sugar in individuals with prediabetes and diabetes mellitus. DIETARY PROVISIONS PREPARATION INFORMATION, An enhanced fiber diet is obtained by requesting a Controlled A diet. The Controlled A Menu offers an average of approximately 33 grams dietary fiber per day. NYS DOCCS Therapeutic Diet Manual April 2018 Page 14.


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