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Medical Statement for Student with Special Dietary Needs FOOD & NUTRITION DEPARTMENT **Please Note** This form is required for any menu substitutions or accommodations due to special dietary needs.
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How to fill out medical statement for student

How to fill out a medical statement for a student?
01
Obtain the medical statement form from the student's school or educational institution. This form is typically provided by the school's administration or health services department.
02
Begin by filling out the student's personal information such as their full name, date of birth, and student identification number.
03
Provide the contact information for the student's parent or guardian. This may include their name, phone number, and email address.
04
Fill in the details of the student's medical history, including any pre-existing conditions, allergies, or chronic illnesses. It is important to be thorough and accurate in providing this information to ensure the student's well-being.
05
If the student is currently taking any medications, include the names of the medications, their dosages, and the frequency of administration. This is crucial for proper management of the student's health while they are at school.
06
Indicate any specific medical procedures or treatments that the student may require during school hours. This could include the administration of medication, use of medical equipment, or any other medical interventions necessary for the student's well-being.
07
If applicable, provide any additional information or instructions that the school should be aware of regarding the student's medical needs. This could include dietary restrictions, physical limitations, or any other relevant information.
08
Sign and date the medical statement form, and ensure that the parent or guardian also signs it.
09
Return the completed medical statement form to the school's administration or health services department as per their instructions.
Who needs a medical statement for a student?
01
Students with chronic illnesses or medical conditions that require regular monitoring or specific care while at school.
02
Students who require medication to be administered during school hours.
03
Students who have documented allergies or dietary restrictions that may require special attention.
04
Students who have physical disabilities or limitations that affect their mobility or require adaptive equipment.
05
Students who have experienced recent injuries or surgeries and require additional support or accommodations for their recovery.
06
Students participating in sports or other physically demanding activities where there is a higher risk of injury or health complications.
07
Students who have a history of seizures, asthma, diabetes, or any other medical condition that may require immediate medical intervention.
08
Students who have experienced a recent significant change in health status, such as the onset of a new medical condition or the completion of a treatment regimen.
Please note that the specific requirements for a medical statement may vary depending on the educational institution and local regulations. It is always advisable to consult with the student's school or health services department for any specific guidelines or forms that need to be followed.
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