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This document is a medical statement required for participants in the Child and Adult Care Food Program to request food substitutions based on medical conditions or allergies. It must be completed

How to fill out medical statement for participants

How to fill out Medical Statement for Participants Requiring Food Substitutions

1. Begin by downloading the Medical Statement form from the designated website or obtaining a hard copy from the appropriate office.
2. Fill in your personal information at the top of the form, including your name, date of birth, and contact information.
3. Indicate the specific food allergies or intolerances you have in the designated section.
4. Provide detailed information about the severity of your allergies or dietary needs.
5. If applicable, include a note from your healthcare provider or a registered dietitian confirming your food substitutions.
6. Sign and date the form to certify that the information provided is accurate.
7. Submit the completed form to the relevant program or organization overseeing your food service.

Who needs Medical Statement for Participants Requiring Food Substitutions?

1. Individuals with food allergies or intolerances that require special dietary accommodations.
2. Participants in programs or events that do not offer flexible food options.
3. Parents or guardians of children with specific dietary needs attending school or organized activities.

People Also Ask about

What areas have been updated in CACFP to expand the food options?

Changes that Impact CACFP include: Changing limits for breakfast cereals and yogurt from total sugars to added sugars. Allowing vegetables to be substituted for grains in programs that primarily serve American Indian or Alaska Native children, as well as in Guam and Hawaii.

What are the 5 main food group categories?

Enjoy food from each of the five food groups and you'll be getting a fantastic mix of the best nutrients and vitamins. 1 Carbohydrates. Carbohydrates give you energy, calcium and B vitamins. 2 Protein. 3 Dairy products. 4 Fruit and vegetables. 5 Fats and sugars.

What are the 5 meal components?

The CACFP guides you on how to provide healthy meals using five food components which make up the meal service requirements: grains, fruits, vegetables, meats/meat alternates and milk.

What are the 5 major components of food?

The major nutrients in our food are carbohydrates, proteins, fats, vitamins and minerals. In addition, food also contains dietary fibres and water. Carbohydrates and fats mainly provide energy to our body.

What are the 5 components of the CACFP?

There are 5 components of the CACFP meal pattern, they are milk, fruit, vegetable, meats/meat alternates, and grains.

What is a medical statement for special dietary needs?

The licensed medical practitioner's statement must identify: • an explanation of how the child's physical or mental impairment restricts the child's diet; • the food(s) to be avoided; and • the food or choice of foods that must be substituted.

What are the 5 food components of Cacfp?

The CACFP lunch and supper meal patterns requires all five food components to be offered: milk, meat/meat alternates, vegetables, fruits, and grains.

For pdfFiller’s FAQs

What is Medical Statement for Participants Requiring Food Substitutions?

A Medical Statement for Participants Requiring Food Substitutions is a document that provides information about a participant's dietary needs due to medical or health-related conditions, allowing them to receive appropriate food accommodations.

Who is required to file Medical Statement for Participants Requiring Food Substitutions?

Individuals or guardians of participants who have specific dietary needs due to medical conditions, allergies, or disabilities that require food substitutions must file the Medical Statement.

How to fill out Medical Statement for Participants Requiring Food Substitutions?

To fill out the Medical Statement, one must provide details about the participant, describe their dietary restrictions, list the required food substitutions, and may need to have the form signed by a licensed medical professional.

What is the purpose of Medical Statement for Participants Requiring Food Substitutions?

The purpose of the Medical Statement is to ensure that participants receive meals that accommodate their medical dietary needs, promoting their health and safety while participating in programs.

What information must be reported on Medical Statement for Participants Requiring Food Substitutions?

The information that must be reported includes the participant's name, details of their medical condition, specific food allergies or intolerances, the necessary food substitutions, and the signature of a healthcare provider.