ADIME Note Example & Template (Outpatient MNT)
A copy-paste ADIME template, two complete outpatient MNT examples (initial and follow-up), and what each section needs so the note supports the claim.
By Javier Alvarez · Published · 6 min read
An ADIME note documents a nutrition visit in the four steps of the Nutrition Care Process: Assessment, Diagnosis (usually a PES statement), Intervention, and Monitoring & Evaluation. Below is a template you can copy, two complete outpatient examples (an initial MNT visit and a follow-up), and a section-by-section list of what payers look for. Every patient detail here is invented.
A quick note on sources. The Nutrition Care Process and its standardized terms belong to the Academy of Nutrition and Dietetics (eatrightpro.org). We only use a few common terms in the examples. For the official term lists, see the Academy's freely available NCP terms or the eNCPT subscription.
The ADIME template (copy-paste)
ADIME is clinical by design and has no place for billing details. In private practice you need both, so this template adds a visit header on top. That header answers what a reviewer checks first.
VISIT
Date of service: Visit type: Initial / Follow-up
Start–stop time: Total face-to-face minutes:
Modality: In person / Video (patient at home, state: __) / Audio-only (reason: __)
CPT × units: ICD-10 (primary first):
Referring provider + NPI (if required): Place of service:
A — NUTRITION ASSESSMENT
Reason for referral / chief concern:
Food & nutrition history (intake pattern, beverages, supplements, meal timing):
Anthropometrics (ht, wt, BMI, weight change + timeframe):
Biochemical data (labs + date + source):
Nutrition-focused physical findings (if assessed):
Client history (dx, meds relevant to nutrition, social/access factors):
Readiness / barriers:
D — NUTRITION DIAGNOSIS (PES)
[Problem] related to [etiology] as evidenced by [signs/symptoms].
I — NUTRITION INTERVENTION
Education / counseling delivered (topic + method):
Goals set with the patient (specific, measurable):
Materials provided:
Coordination (letter to referring provider, etc.):
M&E — MONITORING & EVALUATION
Indicators to track + target:
Progress on prior goals (follow-ups):
Next visit (interval + focus):
Signature, credentials, date:
The header lines matter as much as the clinical sections. Start and stop times are what support your units. Under CPT's midpoint rule, 53 to 67 minutes is 4 units of a 15-minute code (see the 8-minute rule or the units calculator). The referring provider line is required for Medicare MNT and for any commercial plan that asks for a referral.
Example 1: initial MNT visit (invented)
A 47-year-old referred by her primary care physician for elevated LDL and weight gain. Commercial PPO; the plan covers MNT for these diagnoses (verified before the visit). Video visit, patient at home.
VISIT
Date of service: [date] Visit type: Initial
Start–stop: 10:02–11:04 Total face-to-face: 62 min
Modality: Video, patient at home (state: [state])
CPT × units: 97802 × 4 ICD-10: E78.00, E66.811, Z68.32
Referring provider: [name], NPI [##########] POS: 10
A — NUTRITION ASSESSMENT
Referral for LDL 172 mg/dL and 18 lb weight gain over 2 years (labs dated [date],
from referral packet). 24-h recall + typical-day review: fast-food lunch 4–5x/week,
full-fat cheese daily, ~1 serving vegetables/day, sweetened coffee drink most
mornings. Ht 5'5", wt 192 lb (clinic weight in referral packet, dated [date]),
BMI 32.0. Meds: none relevant per patient. Works 10-h shifts,
eats lunch in car. Motivated by family history of early heart disease; main
barrier is time at lunch.
D — NUTRITION DIAGNOSIS
Intake of types of fats inconsistent with needs (saturated fat) related to
reliance on fast-food lunches and
limited knowledge of lower-saturated-fat options, as evidenced by recall showing
fast food 4–5x/week and daily full-fat cheese, and LDL 172 mg/dL.
I — NUTRITION INTERVENTION
Education on sources of saturated fat and label reading (reviewed 3 of the
patient's usual lunch items on screen). Counseling using a goal-setting approach:
patient chose (1) pack lunch 3 of 5 workdays, (2) swap daily cheese for a
lower-fat option. Built 3 no-cook lunch options together. Handout: label-reading
guide. Summary letter to referring physician.
M&E — MONITORING & EVALUATION
Track: packed lunches/week (target 3), cheese swap (daily), weight.
Request repeat lipid panel at PCP's next draw. Follow-up in 3 weeks, 30 min,
focus: lunch plan review + fiber.
[Signature], [Name], RDN, LD — [date]
Why it supports the claim: the 62 minutes are documented and support 4 units of 97802. The diagnoses on the claim appear in the note, with the lab value and BMI that support them. The PES statement ties the problem to something the visit addressed. The goals can be measured at the next visit. The BMI code (Z68.32) is a secondary code next to a condition code, not the primary diagnosis on its own; see Z68 BMI codes and E66 obesity codes for how these pair.
Example 2: follow-up visit (invented)
Same patient, three weeks later, in person.
VISIT
Date of service: [date] Visit type: Follow-up
Start–stop: 14:30–15:01 Total face-to-face: 31 min
Modality: In person
CPT × units: 97803 × 2 ICD-10: E78.00, E66.811, Z68.31
Referring provider: [name], NPI [##########] POS: 11
A — NUTRITION ASSESSMENT
Packed lunch 3/5 workdays in 2 of the last 3 weeks (patient log). Cheese swap
done daily. Fiber: ~12 g/day by recall; 1–2 servings vegetables/day. Wt 188 lb
(clinic scale), BMI 31.3. No new labs yet. Reports lunches "easier than
expected"; barrier now is evening snacking after late shifts.
D — NUTRITION DIAGNOSIS
Previous diagnosis (types of fats inconsistent with needs): improving, as evidenced by
cheese swap and packed-lunch log. New: Inadequate fiber intake related to low
vegetable and whole-grain intake, as evidenced by recall showing ~12 g/day.
I — NUTRITION INTERVENTION
Education on fiber sources; patient chose to add 1 serving of beans or lentils
to packed lunches and a vegetable at dinner 5 nights/week. Brief plan for
post-shift snacks (2 options chosen by patient).
M&E — MONITORING & EVALUATION
Prior goals: lunch goal met 2 of 3 weeks; cheese swap met. New targets: fiber
~20 g/day by next visit; snack plan used 4+ nights/week. Repeat lipids pending
(PCP). Follow-up in 4 weeks.
[Signature], [Name], RDN, LD — [date]
Why it supports the claim: it shows this visit's findings, not a copy of the last note. It measures progress against the goals set before. The 31 minutes support 2 units of 97803. When to use 97802 vs. 97803 is explained in 97802 vs. 97803.
What payers look for in each section
Payers don't grade your format. They check whether this note justifies this claim line. For MNT, that means:
| Section | What a reviewer looks for | Common weak spot |
|---|---|---|
| Visit header | Date, time or minutes, rendering RD, referring provider when required | No start/stop times, so units can't be verified |
| Assessment | Why this patient needs MNT now: the condition, data, and date of the data | Data with no date or source ("A1c high") |
| Diagnosis | A nutrition problem that the medical diagnosis on the claim can explain | Nutrition diagnosis that doesn't connect to the billed ICD-10 code |
| Intervention | What you actually did this visit, specifically | "Discussed healthy eating" |
| M&E | Measurable targets, progress since last time, next step | The same plan copied every visit |
| Signature | Your signature, credentials and date on each note | Unsigned drafts; late signing without an attestation |
Medicare adds its own requirements for MNT: a diagnosis of diabetes or renal disease, a physician referral, and hours limits (NCD 180.1). Commercial plans vary, so check each plan's policy. For signatures, CMS says that if you use a scribe, "including artificial intelligence technology," you sign the entry to authenticate it (MLN905364). An AI-drafted note is your note once you sign it, so read it before you sign.
For what "medical necessity" looks like on paper, see charting for medical necessity.
ADIME or SOAP?
Both work. SOAP is easier for referring physicians to read, and ADIME follows how dietitians think through a visit. We wrote the same visit both ways in ADIME vs. SOAP notes. If your practice uses SOAP, start from our SOAP note templates. If the PES statement is the hard part, use the PES statement examples or the free PES statement builder.
The whole documentation picture, including time and units, medical-necessity wording, late entries and records requests, is in our guide to MNT documentation.
Sources
- Academy of Nutrition and Dietetics — Nutrition Care Process
- NCPro — Freely available NCP terms
- NCD 180.1 — Medical Nutrition Therapy
- CMS MLN905364 — Complying with Medicare Signature Requirements (July 2025)
Sources checked . Payer rules change; verify the member's benefits.
Frequently asked questions
What does ADIME stand for?
Assessment, Diagnosis, Intervention, and Monitoring and Evaluation. They're the four steps of the Academy of Nutrition and Dietetics' Nutrition Care Process, written as sections of a note. The Diagnosis section holds the nutrition diagnosis, usually written as a PES statement.
Is ADIME accepted by insurance companies?
Yes. Payers don't require a particular format. They check whether the note supports the claim: date of service, the time that supports the units billed, a diagnosis that supports the service, what you did, the plan, and your signature and credentials. An ADIME note that includes those items works just as well as a SOAP note.
Where do time and billing codes go in an ADIME note?
ADIME has no billing section, so add a short visit header or footer: start and stop times (or total face-to-face minutes), CPT code and units, ICD-10 codes, place of service, and the referring provider when the payer requires a referral. Reviewers look for these first.
How long should an outpatient ADIME note be?
Long enough to show why the visit was needed and what happened, and no longer. Most outpatient MNT notes fit on one page. Specific findings and a measurable goal matter more than length. A long note of copied history is harder to review than a short, specific one.
Can I copy last visit's ADIME note forward?
Copy the stable background if you want, but write the assessment, intervention and evaluation fresh each visit. Notes that repeat word for word across visits are a common red flag in payer reviews because they don't show what happened at this visit.
Part of MNT documentation. Start with How to Write an MNT Note That Gets Paid.