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PHYSICIAN'S REQUEST FOR SPECIAL MEALS Student s Name: Student #: Date of Birth: / / Parent/Guardian s Name (print): Daytime Telephone: School: Grade: Students with a disability or medical condition
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Physician's request for food is a document or form that a physician fills out to request specific food or dietary requirements for a patient under their care.
The physician who is responsible for the patient's care is required to file the physician's request for food.
To fill out the physician's request for food, the physician must provide the patient's information, including their name and dietary restrictions, and specify the requested food or dietary requirements.
The purpose of the physician's request for food is to ensure that patients receive the necessary and appropriate food or dietary requirements based on their medical condition.
The physician must report the patient's name, medical conditions or dietary restrictions, and the specific food or dietary requirements requested.
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