Risk Assessment Inventory Aspiration

Tri-Counties Regional Center Risk Assessment Inventory – Aspiration

The ID Team should consider the need to address any identified risk factor including further evaluation by the approved professional or clinical team.

Personal Risk Factors √ If Risk Factor Present Impaired level of consciousness (Ex. sleepy/tired or post- seizure) History of GERD or reflux disease

Neurological deficits (Ex. Stroke, Cerebral palsy) Coughing, choking, gagging or excessive throat clearing episodes when eating or drinking Weak cough or inability to clear throat

Frequent upper respiratory illness or pneumonias

History of rumination or frequent emesis/vomiting Mouth–stuffing behaviors; over-filling his or her mouth when eating Tendency to swallow food with little or no chewing

Seizure disorder

Elderly

Person:______Date______