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Review of a Hospital’s Diet Manual

MCN Question of the Week

Review of a Hospital’s Diet Manual


Does the diet manual have to be updated every year?


CMS regulations require the therapeutic diet manual to be reviewed and approved by the dietitian and medical staff at least every five (5) years. Joint Commission standard PC.02.02.03 and NIAHO standard DS. 3 have the same requirements.

CMS regulation §482.28(b)(3) is as follows:

  • A current therapeutic diet manual approved by the dietitian and medical staff must be readily available to all medical, nursing, and food service personnel.
  • Interpretive Guidelines:
    • The therapeutic diet manual must be approved by the dietitian and the medical staff. The publication or revision date of the approved therapeutic diet manual must not be more than 5 years old.
    • The therapeutic diet manual (or copies of it) must be available to all medical, nursing and food service personnel.
    • The diet manual must be written in accordance with the current national standards, such as RDA or DRI.
    • The diet manual should Include the different types of therapeutic diets routinely ordered at the hospital; and
    • The diet manual should be consistently used as guidance for ordering and preparing patient diets

Related Products from MCN Healthcare:

Nutritional Services Policy and Procedure Manual




Regulatory Compliance Solutions for Healthcare Organizations,
Including Policy Management Software, Policy Library Templates,
StayAlert! – Regulatory Alert System, and Learning Management System




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