Documentation
How to Write PES Statements (With 25 Examples by Condition)
How to write PES statements that hold up: structure, NCP diagnosis domains, quality checks, and 25 example PES statements organized by condition.
You know the formula — Problem, Etiology, Signs and symptoms — but at 6pm with three notes left, the PES statement is where charting stalls. Too vague and it doesn't support your claim. Too medical and it isn't a nutrition diagnosis at all. And a weak PES statement quietly undermines the medical necessity your reimbursement depends on.
This guide covers the anatomy, the quality checks, and 25 ready-to-adapt examples organized by the conditions private-practice RDs actually see. All examples are generic and fictional — swap in your patient's real data.
The anatomy: P related to E as evidenced by S
Every PES statement has exactly three parts joined by two fixed phrases:
| Part | What it is | Test |
|---|---|---|
| Problem (P) | The nutrition diagnosis — from NCP terminology | Can you resolve or improve this with nutrition intervention? |
| Etiology (E) | The root cause, joined by "related to" | Does your intervention target this cause? |
| Signs/symptoms (S) | The evidence, joined by "as evidenced by" | Is it measurable, so you can show progress at follow-up? |
The Nutrition Care Process groups diagnoses into three domains:
- NI (Intake): too much, too little, or the wrong balance — excessive energy intake, inadequate protein intake, excessive sodium intake.
- NC (Clinical): nutrition problems tied to medical or physical status — altered GI function, impaired nutrient utilization, swallowing difficulty.
- NB (Behavioral-environmental): knowledge, beliefs, behaviors, access — food- and nutrition-related knowledge deficit, disordered eating pattern, limited access to food.
Three quality checks before you sign
- One problem per statement. If you wrote "and" in the P, you probably have two diagnoses. Pick the one your intervention targets first.
- An etiology you can actually intervene on. "Related to type 2 diabetes" gives you nothing to treat — you can't counsel away the diagnosis. "Related to limited knowledge of carbohydrate counting" gives your intervention a target and your follow-up note a storyline.
- Measurable evidence. "As evidenced by poor diet" fails an audit sniff test. "As evidenced by 24-hr recall showing ~2,300 kcal vs. estimated 1,700 kcal needs" survives one. Numbers, recall data, lab values, food-log frequency — evidence you can re-measure at the next visit.
25 example PES statements by condition
Every example below is fictional and generic. Adjust the diagnosis label, etiology, and evidence to your patient's actual data.
Diabetes and prediabetes
- Inconsistent carbohydrate intake (NI-5.8.4) related to limited knowledge of carbohydrate counting as evidenced by patient-reported skipped meals followed by large evening carb loads and glucose logs ranging 70–240 mg/dL.
- Excessive carbohydrate intake (NI-5.8.2) related to frequent consumption of sugar-sweetened beverages as evidenced by diet recall showing ~3 sodas daily (~450 kcal from added sugar) and A1c above goal.
- Food- and nutrition-related knowledge deficit (NB-1.1) related to new diagnosis of type 2 diabetes and no prior nutrition education as evidenced by patient unable to identify carbohydrate-containing foods during assessment.
- Irregular meal timing pattern (NB-1.5) related to rotating night-shift work schedule as evidenced by reported 10+ hour daytime fasts followed by post-shift eating and fasting glucose variability per meter download.
- Excessive energy intake (NI-1.3) related to reliance on convenience foods during workday as evidenced by 24-hr recall ~700 kcal above estimated needs and 6-lb weight gain over 3 months.
Weight management
- Excessive energy intake (NI-1.3) related to portion sizes exceeding needs at evening meal as evidenced by food-log review showing dinner portions ~2× estimated serving and BMI 34.
- Physical inactivity (NB-2.1) related to sedentary occupation and reported lack of structured routine as evidenced by patient report of <2,000 steps/day and no planned activity in typical week.
- Undesirable food choices (NB-1.7) related to eating in response to work stress as evidenced by self-reported nightly high-energy snacking and food log showing ~500 kcal after 9pm on 6 of 7 days.
- Limited adherence to nutrition-related recommendations (NB-1.6) related to competing caregiving demands as evidenced by patient completing 1 of 3 agreed goals and food logs on 2 of 14 days.
- Inadequate protein intake (NI-5.6.1) related to skipped breakfast and low-protein lunch pattern as evidenced by diet recall averaging ~45 g protein/day vs. estimated 90 g needs during intentional weight loss.
GI conditions
- Altered GI function (NC-1.4) related to suspected FODMAP intolerance as evidenced by patient-reported bloating and urgency within 2 hours of high-FODMAP meals on symptom log.
- Inadequate fiber intake (NI-5.8.5) related to limited knowledge of fiber sources as evidenced by diet recall showing ~10 g fiber/day and reported chronic constipation.
- Inadequate oral intake (NI-2.1) related to fear of triggering GI symptoms as evidenced by elimination of multiple food groups, intake ~60% of estimated needs, and 8-lb unintentional weight loss in 2 months.
- Food- and nutrition-related knowledge deficit (NB-1.1) related to new celiac disease diagnosis as evidenced by patient unable to identify hidden gluten sources and continued symptoms despite attempted gluten avoidance.
- Excessive fat intake (NI-5.5.2) related to frequent fried-food consumption as evidenced by diet history showing fried meals 5×/week and postprandial symptoms consistent with reported gallbladder disease.
Renal (CKD)
- Excessive sodium intake (NI-5.10.2) related to reliance on processed and restaurant foods as evidenced by diet recall estimating ~4,500 mg sodium/day vs. 2,300 mg recommendation and elevated blood pressure.
- Excessive potassium intake (NI-5.10.2) related to limited knowledge of potassium content in foods as evidenced by serum potassium 5.6 mEq/L and recall showing daily high-potassium food choices.
- Excessive protein intake (NI-5.6.2) related to use of protein supplements without guidance as evidenced by estimated intake ~1.6 g/kg/day vs. 0.8 g/kg goal for stage 3b CKD.
- Food- and nutrition-related knowledge deficit (NB-1.1) related to no prior renal nutrition education following CKD diagnosis as evidenced by patient unable to name phosphorus-containing foods during assessment.
Eating patterns and disordered eating
- Disordered eating pattern (NB-1.5) related to rigid self-imposed food rules as evidenced by reported elimination of entire food groups, eating alone to avoid observation, and preoccupation with "clean" foods.
- Inadequate energy intake (NI-1.2) related to prolonged restrictive dieting as evidenced by reported intake ~1,000 kcal/day, fatigue, and cold intolerance.
- Irregular eating pattern (NB-1.5) related to daytime restriction followed by loss-of-control evening eating as evidenced by food log showing no intake before 3pm and reported binge episodes 3×/week.
General adult and pediatric-adjacent
- Inadequate fluid intake (NI-3.1) related to reduced thirst perception and forgetting to drink as evidenced by estimated intake ~700 mL/day and reported dark urine and constipation.
- Undesirable food choices (NB-1.7) related to limited cooking skills and time as evidenced by diet history showing takeout 8+ meals/week and vegetable intake <1 serving/day.
- Excessive intake of energy-dense snacks (NI-1.3) related to unstructured after-school eating environment as evidenced by caregiver-reported daily sweetened snacks and beverages and BMI-for-age above the 95th percentile.
The mistakes that weaken notes
- Vague evidence. "Poor eating habits" is an opinion. Log data, recall numbers, labs, and weights are evidence.
- Medical diagnosis as the problem. "Type 2 diabetes related to..." is not a nutrition diagnosis. The medical dx drives your ICD-10 coding; the PES names what you treat.
- Etiology restating the problem. "Excessive energy intake related to eating too much" goes nowhere. Ask why — knowledge, environment, schedule, stress.
- Evidence you can't re-measure. If the S can't improve on paper, you can't document progress, and follow-up notes lose their justification.
- Copy-paste drift. A PES carried forward unchanged across six visits tells a reviewer nothing happened in six visits.
Why the PES matters for getting paid
Reviewers checking medical necessity want a chain: a covered diagnosis, a nutrition problem tied to it, an intervention that addresses that problem, and evidence of monitoring. The PES statement is links two and three of that chain, stated in one sentence. When your PES cites measurable evidence and your follow-up notes show it changing, you have a paper trail that supports every 97802 and 97803 you bill — see how MNT codes work for the CPT side.
The hard part isn't the formula. It's reconstructing the evidence — the recall numbers, the log frequency, the exact patient words — hours after the session ended. That's a memory problem, not a writing problem.
How Alva helps: Alva drafts your note from the recorded session (with consent), so the recall data, reported symptoms, and goals that feed a strong PES statement are captured while they're actually said — then it generates the matching CPT/ICD codes and files the claim. All of it for $99/month. Start a 7-day free trial.
Frequently asked questions
What is a PES statement in nutrition?
A PES statement is the standardized format for a nutrition diagnosis in the Nutrition Care Process: Problem related to Etiology as evidenced by Signs and symptoms. It names one nutrition problem, identifies the root cause your counseling can address, and cites the measurable evidence that supports the diagnosis.
Can I use a medical diagnosis like diabetes as the problem in a PES statement?
No. The problem must be a nutrition diagnosis you can resolve or improve through nutrition intervention — for example, inconsistent carbohydrate intake — not the medical condition itself. Diabetes belongs in the etiology or the medical context, and on the claim as the ICD-10 code, but the P in PES is always a nutrition problem.
How many PES statements should one note have?
Usually one, occasionally two if the patient genuinely has two distinct nutrition problems you are actively treating. Prioritize the problem most urgent and most responsive to your intervention. A note with four PES statements usually means one real problem buried under three restatements of it.
Do payers actually read PES statements?
Reviewers rarely grade your PES grammar, but they do check that your note shows a nutrition problem tied to the diagnosis on the claim and an intervention that addresses it. A clean PES statement is the fastest way to demonstrate exactly that chain, which is why it strengthens medical necessity.
What is the difference between NI, NC, and NB diagnoses?
They are the three domains of nutrition diagnoses in the Nutrition Care Process terminology. NI covers intake problems (too much, too little, or imbalanced), NC covers clinical problems (swallowing, GI function, altered lab values), and NB covers behavioral-environmental problems (knowledge deficits, adherence, food access).