PES statement builder
By Javier Alvarez · Updated · 3 min read
| Format | Problem related to Etiology as evidenced by Signs/Symptoms |
|---|---|
| Problem | A nutrition diagnosis the RD can resolve, not a medical diagnosis |
| Etiology | The root cause your intervention targets |
| Signs and symptoms | Measurable evidence you can track at follow-up |
| Domains | Intake, Clinical, Behavioral-environmental |
A PES statement is one sentence, and it's the one most often written in a hurry at the end of the day. When it names a medical diagnosis as the problem, restates the disease as the cause, or cites evidence you can't measure, it stops doing its job: showing what you're treating and how you'll know it worked. This builder assembles the sentence from three parts and checks each one as you type.
How to use the builder
- P, the problem. Pick a common nutrition diagnosis term, grouped by domain (Intake, Clinical, Behavioral-environmental), or choose Write my own. You can edit the wording in the field next to it.
- E, the etiology. Type the cause, or tap a suggestion to start from it. Aim for the thing your intervention will change: a behavior, a knowledge gap, access to food.
- S, the signs and symptoms. Add one or more. Suggestions insert with blanks (
__) for you to fill with the patient's real values. - Read the checks. Fix anything flagged, then copy the statement. Keep and start another holds several statements for the same visit so you can copy them all at once.
Nothing you type leaves your browser.
The quality checklist
The builder runs these checks as you type:
- All three parts are present. A problem with no etiology, or no evidence, isn't a diagnosis yet.
- The problem is a nutrition diagnosis. "Type 2 diabetes" is flagged; "inconsistent carbohydrate intake" is not.
- The etiology is a root cause, not the disease restated. "Related to diabetes" is flagged. "Related to skipping breakfast and lunch, then a large evening meal" is something you can counsel on.
- Every sign is measurable. "Eats a lot" is flagged; "reported intake of about 2,900 kcal/day vs estimated needs of 2,100" is not.
- The signs are separate from the cause. Evidence that repeats the etiology word for word proves nothing.
- No blanks left. Every
__is replaced with a real value before it goes in the note.
These checks catch structure, not clinical judgment. You still decide which diagnosis fits the assessment.
Examples
- Inconsistent carbohydrate intake related to irregular meal timing on shift-work days as evidenced by carbohydrate intake ranging from 20 g to 110 g per meal by food log and an A1c of 8.4%.
- Food- and nutrition-related knowledge deficit related to no prior nutrition education as evidenced by being unable to identify carbohydrate-containing foods.
- Excessive mineral intake (sodium) related to frequent processed and canned foods as evidenced by an estimated sodium intake of about 4,000 mg/day and blood pressure of 148/92 mmHg.
All values are invented. For 25 more, organized by condition, see PES statement examples.
Using PES in an insurance note
Payers don't read the PES statement to pay a claim, but they read it when they audit one. A clear PES connects the ICD-10 code on the claim (the medical reason) to the nutrition problem you treated and the measurable evidence behind it, which is what medical necessity documentation needs to show. Put the PES in the Diagnosis section of an ADIME note, and make your monitoring and evaluation section track the same signs, so the next visit's note shows change against the same numbers.