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MEDICAL STATEMENT FOR STUDENTS REQUIRING SPECIAL MEALS Child Nutrition Services Kansas City Public Schools This statement MUST be updated when there is a change in the diet order. Student Last NameMIFirst
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How to fill out special diets your role

01
To fill out special diets in my role, follow these steps:
02
Receive a special diet request from a patient or their caregiver.
03
Review the patient's medical records and dietary restrictions to understand their specific needs.
04
Consult with the patient's healthcare team to gather any additional information or clarifications on the special diet.
05
Use the provided special diet form or template to document the patient's dietary requirements.
06
Clearly indicate the patient's name, medical record number, and date on the special diet form.
07
Write down the specific dietary restrictions, including foods to avoid or limit and foods that are allowed or recommended.
08
Provide detailed instructions on how to prepare the patient's meals in accordance with the special diet.
09
Communicate the special diet information to the hospital kitchen staff or food service providers to ensure proper meal preparation.
10
Document any additional information or considerations related to the special diet, such as allergies, intolerances, or cultural preferences.
11
Share the completed special diet form with the patient's healthcare team and ensure that it is accurately filed in the patient's medical records.

Who needs special diets your role?

01
Special diets may be needed for various individuals in my role, including:
02
- Patients with specific medical conditions requiring dietary modifications, such as diabetes, cardiovascular diseases, kidney disorders, or gastrointestinal issues.
03
- Patients with allergies or intolerances to certain foods or ingredients.
04
- Patients undergoing specific medical treatments or procedures that require dietary restrictions.
05
- Patients following religious or cultural dietary guidelines.
06
- Patients with specific nutritional needs, such as infants, children, pregnant women, or older adults.
07
- Patients with weight management goals, such as those following a weight loss or weight gain program.
08
It is important to assess each patient individually and collaborate with their healthcare team to determine if a special diet is necessary for their specific needs.
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Special diets are specific dietary plans tailored to meet individual health needs, which may include restrictions or enhancements based on medical conditions or lifestyle choices.
Individuals who follow special dietary plans for medical, ethical, or lifestyle reasons are required to file special diets documents.
To fill out special diets, individuals need to provide detailed information about their dietary restrictions, preferences, and any relevant medical documentation supporting the need for the diet.
The purpose of special diets is to ensure that individuals receive proper nutrition tailored to their specific health needs while managing medical conditions or dietary preferences.
The information that must be reported includes personal details, specific dietary restrictions, medical conditions, and any required documentation from healthcare providers.
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