Diet Prescription

Diet Prescription for Meals at School

Diet

Diet Prescription Form

TO PROCESS THE FORM PLEASE FOLLOW THESE STEPS:

  • Please review the "Diet Prescription for Meals at School" form.

 

  • Give the form to your licensed Physician/Recognized Medical Authority to complete.

 

  • Return the complete form to the School Nurse and or Cafeteria Manager.

USDA Regulations & Guidance:

A child with medical conditions that are NOT disabilities must have licensed physician’s statement that includes:

  • An identification of the medical or other special dietary condition which restricts the child’s diet.
  • The food or foods to be omitted from the child’s diet; and the food or choice of foods to be substituted.

USDA Regulations & Guidance: A child with disability must have licensed Physician’s statement that includes:

The child’s disability

  • An explanation of why the disability restricts the child’s diet.
  • The major life activity affected by the disability.
  • The food or foods to be omitted from the child’s diet, and the food or choice of foods that must be substituted.