Page 1 of 1

Table 3.2. Weight Summary Report

On-Time Quality Improvement Manual for Long-Term Care Facilities

Resident Name

Resident ID

Wt 180 Days Prior

Wt 90 Days Prior

Wt 30 Days Prior

Wt For Week Ending 5/8/10 Week 4

Wt for Week Ending 5/15/10 Week 3

Wt tor Week Ending 5/22/10 Week 2

Wt for Week Ending 5/29/10 Week 1

Wt Change Lb

≥5% Wt Loss ≤30 Days (Any)

≥10% Wt Loss ≤180 Days
(Point - Point)

A

#####1

285.3

275.0

254.5

252.4

256.1

251.7

253.8

2.1, 5/19/10

 

11.3%

B

#####2

172.1

175.3

180.0

180.0

170.0

181.0

171.0

-10.0, 5/19/10

5.6%, 5/12/10

5.0%, 5/24/10

5.5%, 5/24/10

 
Page last reviewed January 2011
Internet Citation: Table 3.2. Weight Summary Report: On-Time Quality Improvement Manual for Long-Term Care Facilities. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/ontimeqimanual/qimanltab3-2.html