<p> Tri-Counties Regional Center Risk Assessment Inventory – Aspiration</p><p>The ID Team should consider the need to address any identified risk factor including further evaluation by the approved professional or clinical team. </p><p>Personal Risk Factors √ If Risk Factor Present Impaired level of consciousness (Ex. sleepy/tired or post- seizure) History of GERD or reflux disease</p><p>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</p><p>Frequent upper respiratory illness or pneumonias</p><p>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</p><p>Seizure disorder</p><p>Elderly </p><p>Person:______Date______</p>