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CHILD AND ADULT CARE FOOD PROGRAM Special Diet Statement for Children The child named below is a participant in the Montana Child and Adult Care Food Program (CA CFP). His/ her child care facility

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How to fill out special diet statement

How to Fill Out a Special Diet Statement:

01

Obtain the form: The first step in filling out a special diet statement is to acquire the form itself. This can usually be done by contacting your healthcare provider or dietitian, who can provide you with the necessary paperwork.

02

Personal Information: Start by filling out your personal information on the form. This typically includes your name, address, date of birth, and contact details. Make sure to double-check the accuracy of this information before proceeding.

03

Medical History: Next, you will need to provide a summary of your medical history. This includes any existing conditions or allergies that require a special diet. Be as thorough as possible, mentioning any dietary restrictions you may have been advised to follow by your healthcare professional.

04

Specific Diet Needs: Indicate your specific dietary needs in detail. It's crucial to be explicit about the types of foods you need to avoid or include in your diet. This can range from allergies to certain ingredients to dietary preferences or requirements due to medical conditions.

05

Supporting Documentation: If applicable, attach any necessary supporting documentation to validate your special dietary needs. This may include letters from healthcare providers, test results, or medical reports. These documents help reinforce the legitimacy of your dietary requirements.

06

Sign and Submit: After completing the form and attaching any required supporting documents, sign and submit the special diet statement. Make sure to follow the designated submission guidelines, whether it's mailing the form, submitting it online, or delivering it in person.

Who Needs a Special Diet Statement?

01

Individuals with Allergies: Those who have severe allergies to certain foods or ingredients often require a special diet statement. This helps ensure that their dietary needs are accommodated and that they are not exposed to allergens that can trigger potentially life-threatening reactions.

02

Individuals with Medical Conditions: Certain medical conditions, such as diabetes, celiac disease, lactose intolerance, or food intolerances, may necessitate a special diet statement. This helps healthcare providers and food service professionals to better understand and address the dietary requirements of these individuals.

03

Dietary Preferences or Religious Restrictions: Some individuals may have specific dietary preferences or religious restrictions that warrant a special diet statement. Whether it's vegetarianism, veganism, or following kosher or halal guidelines, a special diet statement can advocate for the provision of suitable food options that align with these preferences or restrictions.

In summary, filling out a special diet statement involves providing accurate personal information, detailing your medical history, specifying your dietary needs, and submitting any required supporting documentation. This statement is essential for individuals with allergies, medical conditions, or specific dietary preferences or religious restrictions to ensure their dietary needs are met.

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What is special diet statement?

Special diet statement is a form that specifies the dietary restrictions or requirements of an individual.

Who is required to file special diet statement?

Individuals who have specific dietary needs or restrictions are required to file a special diet statement.

How to fill out special diet statement?

Special diet statement can be filled out by providing details of the dietary restrictions or requirements of the individual.

What is the purpose of special diet statement?

The purpose of special diet statement is to ensure that individuals with specific dietary needs or restrictions receive appropriate meals.

What information must be reported on special diet statement?

Special diet statement must include details of the individual's dietary restrictions or requirements, along with any relevant medical information.

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