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Statement of Special Diet Orders from a Doctor for Students with Disabilities and Life Threatening Allergic Reactions Please return the completed form to Child Nutrition Program staff on your campus.

How to fill out statement of special diet

How to Fill Out Statement of Special Diet:

1. Read the instructions: Before starting to fill out the statement of special diet, carefully read the provided instructions. This will help you understand the requirements and ensure that you provide the necessary information.
2. Personal information: Begin by providing your personal details in the designated spaces. This typically includes your full name, contact information, date of birth, and any other information requested.
3. Medical condition: Indicate the specific medical condition or dietary restriction that requires a special diet. Clearly describe the condition or restriction, providing any relevant medical documentation or notes from healthcare professionals, if required.
4. Dietary needs: Specify your dietary needs in detail. This may include allergies, food intolerances, specific food groups to avoid or include, and any other important instructions related to your special diet.
5. Length of special diet: Indicate the duration for which the special diet needs to be followed. This could be a specific date range or an ongoing requirement. If there are any exceptions to the diet for certain circumstances or events, mention them here as well.
6. Supporting documents: Attach any supporting documents that validate your need for a special diet. This could include medical reports, allergies test results, doctor's notes, or any other relevant documentation.
7. Signature and date: Sign and date the statement of special diet to confirm that the information provided is accurate and complete. Take note of any additional signatures or witness requirements if specified.

Who needs a statement of special diet?

1. Individuals with medical conditions: People with medical conditions such as diabetes, celiac disease, food allergies, or other dietary restrictions requiring a special diet may need to provide a statement of special diet.
2. Students or employees: Schools or workplaces may require a statement of special diet for students or employees who have specific dietary needs due to medical conditions or religious beliefs.
3. Hospital patients: Patients who are admitted to hospitals or healthcare facilities and require a special diet due to their medical condition will likely need to provide a statement of special diet.
4. Travelers: Individuals traveling with specific dietary restrictions may need a statement of special diet. This can help ensure that their dietary requirements are met during their travels, such as on flights or at hotels.

Remember, it is always essential to check with the specific institution or organization requesting the statement of special diet to ensure that you meet their requirements properly.

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What is statement of special diet?

Statement of special diet is a form that individuals required to file in order to request specific dietary accommodations due to medical or religious reasons.

Who is required to file statement of special diet?

Individuals with medical or religious dietary restrictions are required to file a statement of special diet.

How to fill out statement of special diet?

To fill out a statement of special diet, individuals must provide detailed information about their specific dietary restrictions, medical conditions, or religious beliefs that require accommodation.

What is the purpose of statement of special diet?

The purpose of the statement of special diet is to ensure that individuals with special dietary needs receive appropriate accommodations in food services or meal planning.

What information must be reported on statement of special diet?

The information that must be reported on a statement of special diet includes specific dietary restrictions, medical conditions necessitating the special diet, and religious beliefs requiring accommodation.