Special Dietary Needs Forms
USDA Child Nutrition Programs support access to healthy meals to all children, including children with disabilities who have special dietary needs. A disability is defined as an impairment that substantially limits a major life activity. This can include allergies and digestive conditions. However, it does not include personal diet preferences. In order for Nutrition Services to properly accommodate your student's special dietary needs in the National School Lunch and Breakfast Program, we must have one of the following forms on file. If you are visiting your physician, please provide them with this form to complete. We cannot accept incomplete doctor's notes, allergy testing forms, diet orders, etc. If a child's IHP plan includes the information required in the medical statement, it is not necessary to submit a separate medical statement. If an IHP contains insufficient allergy information, additional information may be requested to properly accommodate the student. If your student has a life threatening allergy, please contact your school to create an individualized health plan.
How do I get Special Dietary accommodations for my child?
Please fill out the Special Dietary Accommodations form signed by the recognized medical authority and turn it into your student's school.
Recognized Medical Authorities Include: Physicians (MD), Physicians Assistants (PA-C), ARNP, Doctors of Osteopath, and Naturopathic Physicians (ND).
Does not include: Registered Dietitians, nurses without the ability to prescribe medicine, and naturopaths without ND credentials
The request must include:
- Food(s) to be omitted/avoided from the child’s diet.
- How the ingestion of the food impacts the child.
- Food(s) to be substituted.
Continued communication is necessary for the most up-to-date care. Times to communicate with your school may include:
• New special dietary needs.
• Updated restrictions (for example: your child was not able to eat tomatoes, but now they can).
• Questions or concerns about your child’s care.