Long Term Care Tube Fe Order Trackereding Orders - Physician'S Order Sheet Page 2
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1
2ENTERAL NUTRITION FORMULARY
PRODUCT
COMPOSITION
INDICATIONS FOR USE
ISOSOURCE
1.2 Calories / ml
General maintenance for calorie & protein requirements.
43g Protein / L
FIBERSOURCE HN
1.2 Calories / ml
Maintenance of caloric needs with increased protein
53g Protein / L
content. Also contains fiber.
ISOSOURCE VHN
1 Calorie / ml
High protein isotonic formula for patients with high protein
62g Protein / L
needs and caloric restrictions.
ISOSOURCE 1.5
1.5 Calories / ml
High calorie, high protein formula with fiber for patients
68g Protein / L
with high nutrition needs and / or volume restrictions.
VIVONEX PLUS
1 Calorie / ml
Elemental diet containing free amino acids for patients
45g Protein / L
with GI impairment.
NUTRI-HEP
1.5 Calories / ml
Lactose free, moderate protein concentrated formula for
40g Protein / L
hepatic patients w/ encephalopathy. 50% of protein is BCAA.
NOVASOURCE
2 Calories / ml
Lactose free, moderate protein, low electrolyte concentrated
RENAL
74g Protein / L
formula with vitamins & minerals for renal patients on
dialysis.
SUPLENA
2 Calories / ml
Lactose free, low protein, low electrolyte concentrated
30g Protein / L
formula with vitamins & minerals for pre-dialysis rental
patients.
RESOURCE
1.06 Calories / ml
Moderate protein, low carbohydrate formula. May be
DIABETIC
63g Protein / L
indicated for DM patients.
DIABETISOURCE
1 Calorie / ml
Moderate protein, low carbohydrate formula. May be
50g Protein / L
indicated for DM patients.
ORAL SUPPLEMENTS
PRODUCT
COMPOSITION
INDICATIONS FOR USE
RESOURCE PLUS
1.5 Calories / ml
Lactose free, gluten free, high protein, high caloric content
55g Protein / L
supplement for increased nutritional needs and / or fluid
restricted patients.
RESOURCE FRUIT
180 Calories / ml
Fruit flavored, fat free supplement for patients requiring
BEVERAGE
9g Protein / 240 ml
clear liquid diets.
MODULAR PRODUCTS
PRODUCT
COMPOSITION
INDICATIONS FOR USE
PROMOD
28 Calories &
Whey protein powder additive to foods and / or tube feedings.
5g Protein / scoop
feedings. Supplement for increased nutritional needs and
/ or fluid
PART OF THE MEDICAL RECORD
PAGE 2 of 2
Tube Feeding Physicians Order Sheet_LONG TERM CARE_MEDICAL AFFAIRS
8850342 Rev 05/05
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