Guide to OUTpatient Nutrition Services

The UCSF Nutrition Counseling Clinic offers general nutrition counseling to promote wellness and disease prevention through dietary changes. Registered dietitians specializing in pediatric, adolescent, and adult nutrition care offer individualized nutrition counseling to meet your needs and optimize your health and well being. During counseling sessions, dietitians will assess your current eating habits and medical conditions and help you establish individual goals.  A physician's referral is required to schedule an appointment in the nutrition counseling clinic. 

The UCSF Nutrition Counseling Clinic offers appointments at two UCSF Locations:

Nutrition Counseling Clinic, Mount Zion Campus 1701 Divisadero Street, 5th Floor San Francisco, CA Located in General Medicine

Lakeshore Family Medicine Center 1569 Sloat Boulevard, San Francisco, CA

Nutrition Counseling Clinic mailing address and contact information:
505 Parnassus Avenue San Francisco, CA 94143-0212 (415) 353-2291

For patients interested in weight loss, please note that UCSF offers a Weight Management Program for adults though the Department of General Internal Medicine. The pediatric weight management program, Weight Assessment for Teen and Child Health (WATCH) is available through the Department of Pediatrics.

 

Where are Nutrition Services Provided?

 

UCSF Nutrition Counseling Clinic (NCC)
The UCSF Nutrition Counseling Clinic at 400 Parnassus (A435) is staffed by Registered Dietitians to provide individual nutrition counseling appointments for adults, adolescents and children. Patients are seen by appointment only and a physician’s referral is required. For more information or to make an appointment, call 415-353-2291. Patients may also contact the ACC Call Center for an appointment, 415-353-4174. If insurance preauthorization is needed, please wait for authorization before making an appointment. 

Please note that health insurance plans often do not include nutrition counseling as a covered service. Preauthorization is required when nutrition counseling is covered by insurance. Patients should be aware there is a fee for nutrition counseling if it is not covered by their insurance policy.

Clinics with Scheduled Coverage by a Registered Dietitian
Registered Dietitians also have established hours in selected clinics with a high proportion of patients likely to be at nutrition risk or clinics with patients who are treated with medical nutrition therapy. Patients may also be referred to the Nutrition Counseling Clinic. A written referral is required regardless of the location of the RD appointment. Clinics with a Registered Dietitian on site include: 

 

Adult Clinics Pediatric Clinics
ALS Clinic    

Cystic Fibrosis Clinic

Diabetes Clinic

Diabetes Teaching Center

Hepatology Clinic

Insulin Pump Clinic

Lipid Clinic

Obstetrics

Positive Health Practice

Weight Management Program

 

Mount Zion

Breast Care Center

Cancer Resource Center

Chronic Dialysis Unit

Children’s Renal Center    

Cystic Fibrosis Clinic

Diabetes Clinic

Genetics-Metabolic Clinic

GI Clinic

LIFE Clinic

Spinal Defects Clinic

Teen Clinic

Other Nutrition Resources at UCSF

  • Weight Management Program. Call 415-353-2105 for information 
  • Diabetes Teaching Center. Call 415-353-2266 for information. 

Mount Zion locations may be selected if the location is more convenient for the patient.

  • Nutrition Counseling Clinic (request an appointment at Mount Zion) Call 415-353-2291. 
  • Cancer Resource Center at Mount Zion. Call 415-885-3693 
  • Breast Care Center at Mount Zion (for patients with breast cancer). Call 415-885-3700. 

Off-Site Nutrition Services for Some Patients
Certain patients receive care at other sites where the services of a Registered Dietitian would be available. In general, these patients would not require a referral to the Nutrition Counseling Clinic. Examples of off site programs are: 

  • Women, Infants and Children’s Supplemental Food Program (WIC). Low-income pregnant or lactating women and children 5 years old or younger with a medical or nutrition risk may be referred to a WIC clinic for nutrition education and food vouchers. 
  • Chronic Dialysis. Patients with end stage renal disease who undergo dialysis treatment would receive nutrition care from the Registered Dietitian who is employed by the dialysis center used by the patient. 
  • Adult Day Health Centers. General nutrition screening and nutrition education are provided at Adult Day Health Centers. 
  • UCSF Home Care and other home care providers. The services of a Registered Dietitian are provided when medically indicated for patients who receive home care services. 
  • Skilled Nursing Facilities. Registered Dietitians at SNFs provide nutrition screening, nutritional assessment, on-going monitoring of nutritional status and medically prescribed diets. 

Who should provide nutrition services?

 

Guidelines for Nutrition Assessment and Care 

Conditions that may indicate nutrition risk are shown below with guidelines for action.

 

Condition  Action 
Basic nutrition information is needed.  Clinic staff provides written information from this binder or other sources. 
  • Suspected inadequate diet
  • Poor food access.
  • Prolonged poor appetite/inadequate intake
  • Self-restricted diet
  • Dysphagia/swallowing difficulty
                         

  • Refer to social services. 
  • Provide Calorie Booster handout or refer to Nutrition Counseling Clinic. 
  • Provide basic nutrition handout or refer to Nutrition Counseling Clinic. 
  • Speech/OT evaluation, then refer to Nutrition Counseling Clinic. 

 

Unexplained significant weight loss/FTT                        

 

  • Patient now eating and stabilizing/ gaining weight. 
  • Sustained weight loss/poor wt. gain. 
                        

 

  • Monitor; provide Calorie Boosters handout. 
  • Refer to Nutrition Counseling Clinic. 

 

*Nutrition Therapy: Medically prescribed diet or food restriction.                         

  • Patient understands diet principles. 
  • New diet prescription or patient indicates lack of knowledge. 

 

                         

  • No action required unless patient requests a nutrition consultation. 
  • Refer to Nutrition Counseling Clinic. 

 

 

Clinical Nutrition Services

Basic Nutrition Services Your Clinic Staff Can Provide

 

Your clinic staff can provide written information about general, basic nutrition topics. Examples are shown in the table below, along with titles of materials that are available in this binder. Some clinics have additional nutrition education materials on topics of interest to their specific patient population.

Patients who require only basic information would not need a referral to the Nutrition Counseling Clinic.

Topic Resources
Basic, normal nutrition
  •   Food Guide Pyramid 
  •   Hot Food Facts for Cool Kids 
  •   Healthy Eating for Hungry Kids 
  •   Fitness Pyramid for Kids 
  •   Guide to Reading the Food Label 
Infant Nutrition
  •  FoodforBaby’sFirstYear
Weight Management
  • Guidelines for Permanent Weight Loss
Cardiac Risk factor reduction
  • How to Choose Foods Low in Cholesterol and Saturated Fat
Constipation
  • High Fiber Diet
Vitamin and Minerals
  • Iron
  • Calcium
Vegetarian
  • Vegetarian Diets
Increasing Calorie Intake
  • Mixing Instructions for Concentrated Infant Formulas 
  • Fortified Maternal Breastmilk 
  • Instructions for Preparing Special Dilution
    Infant Formulas 
  • Methods to Concentrate Calories in Baby
    Food 
  • Calorie Boosters 
Food Safety
  • Food Safety Tips for Healthy Eating
Other
  • Materials from outside sources that address topics of interest to your clinic population.

Written materials on other topics are available from the Nutrition Services Department. Selected materials are available in Spanish, Russian and Chinese. Please contact the Nutrition Counseling Clinic at 415-353-2291 for more information.

 

Which patients should be referred to Nutrition Counseling Clinic?

 

Common reasons for referrals and the general approach are shown in the table below.

Condition Nutrition Therapy
Obesity/Overweight Individualized weight management plan; consider a referral to the UCSF Weight Management Program for modified fast/meal replacement program.
Diabetes Individualize meal plan; consider referral to UCSF Diabetes Teaching Center.
Lipid disorders Consultation about calorie intake, fat intake, exercise, weight management.
Gastrointestinal disorders Evaluation of diet quality, food intolerances, individualized guidelines for food selection and meal planning.
Congestive Heart Failure/Hypertension Evaluation of current diet, principles of low sodium diet, individualized plan for calorie level to achieve or maintain desired weight goal.
End stage liver disease Calculate and counsel on individualized protein, energy and nutrient intake.
End stage renal disease If on dialysis, advise patient to consult with the dietitian at the dialysis center.  If not on dialysis, calculate and counsel on protein, energy, nutrient and fluid intake to maintain body weight and lean body mass and manage uremic symptoms.
FTT: Unintentional weight loss of > 10% in 6 months Nutrition counseling focused on increasing calorie and nutrient intake.
Suspected inadequate diet due to poor appetite, dysphagia or other medical condition Nutrition counseling focused on increasing calorie and nutrient intake.
Need for tube feeding Initial assessment should be done in hospital or through home care. Monitoring and problem-solving available in NCC.
Need for parenteral nutrition Not provided in NCC. Refer patient to Gastroenterology.
Other conditions determined by the clinic provider Individualized nutrition care plan to achieve desired outcomes depending on patient’s needs and goals identified in provider referral.

 

How do you refer a patient to Nutrition Counseling Clinic?

 

A written physician's referral is required. The referral form can be downloaded from the Outpatient Nutrition Services website and is also kept at each clinic location. The referral can be brought directly to the Nutrition Counseling Clinic mailbox in General Medicine A or B, or sent by campus mail to Box 0310. The Nutrition Counseling Clinic should receive the referral before an appointment is scheduled.

Once the referral has been made, the patient may schedule an appointment through the Call Center 415-353-4174, or directly with the Nutrition Counseling Clinic at 415- 353-2291.
 

 

Does insurance cover appointments in the Nutritiion Counseling Clinic?

 

Nutrition counseling is often not covered as an insurance benefit. Patients should be informed that they may be required to self-pay if their insurance does not authorize nutrition counseling.

If a patient has Brown & Toland coverage, the referring clinic or the Nutrition Counseling Clinic should submit a request for authorization to Brown & Toland. Brown & Toland often covers nutrition counseling for weight management, cholesterol lowering diets, and sometimes diabetes management. If the patient has other insurance, the patient is primarily responsible for obtaining authorization from the insurance company. Authorization should be confirmed in writing before an appointment is scheduled in the Nutrition Counseling Clinic.

 

What services and interventions are provided by the Registered Dietician?

 

The Registered Dietitian provides nutrition assessment and counseling based on the patient’s individual needs. This includes evaluation of current intake and advice for improving the nutrient content of an individual’s diet, as well as medical nutrition therapy. Medical nutrition therapy involves assessment of the nutritional status of patients with a condition, illness, or injury that puts them at nutrition risk. This includes review and analysis of medical and diet history, laboratory values, and anthropometric measurements. Based on the assessment, a nutrition care plan is developed to manage the condition or treat the illness or injury. The plan generally includes the following: (1) Diet modification and counseling leading to the development of a personal diet plan to achieve nutritional goals and desired health outcomes; and (2) Specialized nutrition therapy including recommendations for supplementation with medical foods or nutrient supplements for those unable to obtain adequate nutrients through food intake only.