Hospital Patient Data Form "*" indicates required fields Hospital Reference Number*1 Aut Even Hospital, Kilkenny2 Bantry General Hospital3 Beacon Hospital, County Dublin4 Beaumont Hospital5 Blackrock Clinic, County Dublin6 Bon Secours Hospital Cork7 Bon Secours Hospital Dublin8 Bon Secours Hospital Galway9 Bon Secours Hospital Limerick10 Bon Secours Hospital Tralee11 Cappagh National Orthopaedic Hospital12 Cavan General Hospital13 Clontarf Hospital14 Connolly Hospital Blanchardstown15 Cork University Hospital16 Cork University Maternity Hospital17 Croom UL Hospital18 Ennis UL Hospital, Clare19 Fitzwilliam Clinic, Belfast20 Galway Clinic21 Hermitage Clinic, County Dublin22 Highfield Healthcare23 Kerry University Hospital, Tralee24 Kingsbridge Hospital Sligo25 Letterkenny University Hospital, Donegal26 Limerick University Hospital / UHL27 Limerick University Maternity Hospital28 Lourdes Orthopaedic Hospital Kilcreene29 Louth County Hospital, Dundalk30 Mallow General Hospital, Cork31 Mater Misericordiae University Hospital32 Mater Private Hospital Cork33 Mater Private Hospital Dublin34 Mayo University Hospital, Castlebar35 Mercy University Hospital Cork36 Midland Regional Hospital Mullingar37 Midland Regional Hospital Portlaoise, Laois38 Midland Regional Hospital Tullamore, Offaly39 Monaghan General Hospital40 Naas General Hospital, County Kildare41 Nenagh UL Hospital, County Tipperary42 Our Lady of Lourdes Hospital Drogheda, Louth43 Our Ladys Hospital Navan, Meath44 Peamount Healthcare45 PMC Whitfield Clinic, Waterford46 Portiuncula Hospital Ballinasloe, Galway47 Roscommon County Hospital48 Royal Victoria Eye and Ear Hospital49 Saint Vincent's University Hospital Elm Park50 Saint Colmcilles Hospital Loughlinstown51 Saint James's Hospital, Dublin 852 Saint John's Hospital Limerick53 Saint Josephs Hospital54 Saint Luke's Hospital Kilkenny55 Saint Luke's Hospital Rathgar56 Saint Michael's Hospital Dún Laoghaire57 Sligo University Hospital58 South Infirmary University Hospital Cork59 South Tipperary General Hospital60 St Francis Private Hospital, Mullingar61 St John of God Hospital62 St Vincent’s Private Hospital, Dublin63 Tallaght University Hospital64 University Hospital Galway65 Waterford University Hospital66 Wexford General Hospital67 Newcastle Hospital Co. WicklowMy Hospital isn't listed aboveChoose you hospital number from the list. If you don't see your number on the list please contact us by clicking hereHospital Name If you provide your hospital name above we will automatically assign you a Reference NumberWard Type* eg. Oncology, Gen. Medical, Surgical, Care of elderly, ICU/HDU, RehabilitationNutrition Screening Tool used* Frailty Screening Tool (if used) Was this test carried out in a day ward? Yes No Patient informationAdd Patients Below Number Age Gender Where admitted from Does patient have cancer? Principle diagnosis / reason for admission Weight (KG) Height (M) Recent unintentional weight loss (last 3 - 6 months)? Is patient acutely ill and little food intake for past / next 5 days? Does the patient have reduced appetite? Screening Risk Score Category Frailty score (if screened) Is patient receiving nutrition support Type of Admission Actions Edit Delete There are no Patients. Add Patient Maximum number of patients reached.