Get the free SPECIAL DIET STATEMENT - University of Minnesota - cehd umn

UMCCC Revised 6/07 Special Diet Statement The child named below is a participant in the U.S. Department of Agriculture Child and Adult Care Food Program (CA CFP). His/her child care provider is required

How to fill out special diet statement

How to fill out a special diet statement:

1. Begin by gathering all necessary information, such as the individual's name, contact information, and any medical conditions or allergies they have.
2. Specify the reasons for needing a special diet statement, whether it is due to a medical condition, religious beliefs, or personal preferences.
3. Clearly state the dietary restrictions or requirements that need to be followed, making sure to include any specific foods or ingredients that should be avoided or included in the diet.
4. Include any additional information or instructions that may be helpful, such as the need for meal modifications or specific portion sizes.
5. Sign and date the special diet statement, ensuring that it is confirmed and agreed upon by both the individual and any relevant healthcare professionals or authorized personnel.
6. Keep a copy of the completed special diet statement for your records and provide a copy to any designated individuals or organizations responsible for meal preparations or accommodations.

Who needs a special diet statement?

1. Individuals with specific medical conditions such as diabetes, food allergies, or gastrointestinal disorders may require a special diet statement to ensure their dietary needs are met.
2. Religious or cultural dietary restrictions may also necessitate the use of a special diet statement for individuals who follow specific dietary practices.
3. People with personal preferences or ethical beliefs that influence their food choices may also benefit from having a special diet statement to communicate their dietary needs or restrictions to others.

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What is special diet statement?

Special diet statement is a form that outlines any special dietary requirements or restrictions that an individual may have.

Who is required to file special diet statement?

Anyone who has special dietary requirements or restrictions that need to be accommodated.

How to fill out special diet statement?

Special diet statement can be filled out by providing details of the specific dietary requirements or restrictions in the designated sections.

What is the purpose of special diet statement?

The purpose of special diet statement is to ensure that individuals with special dietary needs are provided with appropriate meals or accommodations.

What information must be reported on special diet statement?

Information such as specific dietary requirements, food allergies, intolerances, or restrictions.