Get the free Food Substitution Medical Statement - Missoula County Public ...

Licensed Physician SIGNATURE MD or DO DATE PRINTED Physician Name Form Review May 2016 PHONE NUMBER Special Dietary Needs Dear Parent/Guardian and Healthcare Provider The information below is an explanation of the Missoula County Public Schools MCPS Additional information may be obtained from MCPS Food and Nutrition Supervisor Stacey Rossmiller /728-2400 ex 3023/ slrossmiller mcps. List the food or foods to be omitted from the student s diet Definitions 1 USDA FNS Instruction 783-2 7 CFR Part...

How to fill out food substitution medical statement

How to fill out food substitution medical statement

1. Read the food substitution medical statement form carefully and familiarize yourself with the instructions and requirements.
2. Gather all the necessary information and documents that will be required to fill out the form, such as medical records, diagnosis, and specific dietary restrictions.
3. Start by providing your personal information in the designated fields, including your name, age, contact information, and any relevant medical history.
4. Next, specify the reason for requesting food substitution and provide a detailed explanation of your medical condition or dietary restrictions that necessitate the need for such substitutions.
5. Indicate the specific food items or ingredients that need to be substituted and provide a detailed description of the alternative options that are suitable for your dietary needs.
6. If you have any preferences or specific requirements when it comes to the substitutions, make sure to mention them in the form.
7. Attach any supporting documents, medical reports, or letters from healthcare professionals that validate your need for food substitution.
8. Double-check all the information provided, ensure that it is accurate and complete.
9. Submit the filled-out form by the designated deadline, either by mail or directly to the relevant authority or institution responsible for processing food substitution requests.
10. Keep a copy of the filled-out form and all the supporting documents for your records.

Who needs food substitution medical statement?

1. Individuals with specific medical conditions that require dietary restrictions may need a food substitution medical statement.
2. People with severe allergies, intolerances, or sensitivities to certain food items may require a food substitution medical statement.
3. Patients with diagnosed medical conditions such as celiac disease, diabetes, food allergies, or gastrointestinal disorders may need to provide a food substitution medical statement.
4. Individuals who are on special diets due to religious, cultural, or ethical reasons may also be required to submit a food substitution medical statement.
5. Students attending educational institutions with food service programs may need a food substitution medical statement to ensure their dietary needs are accommodated.
6. Employees with dietary restrictions who require food substitutions in workplace cafeterias or during work-related events may need to provide a food substitution medical statement.
7. Individuals participating in programs or events where food is provided, such as camps or conferences, may need a food substitution medical statement.
8. Anyone seeking food substitutions in hospitals, nursing homes, or other healthcare facilities may be required to provide a food substitution medical statement.

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What is food substitution medical statement?

A food substitution medical statement is a document that outlines any necessary dietary restrictions or substitutions that need to be made for an individual's medical condition.

Who is required to file food substitution medical statement?

Individuals who have medical conditions that require specific dietary restrictions or substitutions are required to file a food substitution medical statement.

How to fill out food substitution medical statement?

A food substitution medical statement can be filled out by providing information about the individual's medical condition, dietary restrictions, and any necessary substitutions. It must be signed by a healthcare provider.

What is the purpose of food substitution medical statement?

The purpose of a food substitution medical statement is to ensure that individuals with medical conditions receive appropriate dietary accommodations to maintain their health.

What information must be reported on food substitution medical statement?

On a food substitution medical statement, information such as the individual's medical condition, specific dietary restrictions, required substitutions, and healthcare provider's signature must be reported.