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Food & Nutrition Services Department ANNUAL MODIFIED MEAL REQUEST FORM TO BE COMPLETED BY PARENT OR GUARDIAN Name of Student (Last, First): School: Grade: Parent/Guardian Phone: Parent/Guardian Name:
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How to fill out diet order

01
Start by gathering all necessary information such as the patient's personal details, medical history, dietary restrictions, and any specific dietary needs.
02
Assess the patient's nutritional needs and goals based on their medical condition and any recommendations from healthcare professionals.
03
Determine the appropriate calorie intake and macronutrient ratios for the patient's diet.
04
Create a sample menu plan that includes a variety of nutrient-rich foods from different food groups.
05
Consider the patient's food preferences, cultural or religious food restrictions, and any allergies or intolerances.
06
Specify portion sizes and serving recommendations for each meal and snack.
07
Provide clear instructions on food preparation methods, such as cooking techniques, seasoning options, and food storage guidelines.
08
Include any necessary dietary supplements or medications that need to be taken with meals.
09
Clearly outline the guidelines for fluid intake and any restrictions on certain beverages.
10
Finally, review and double-check the diet order form for accuracy and completeness before finalizing and implementing the diet plan.

Who needs diet order?

01
Individuals who need a diet order include:
02
- Patients in hospitals or healthcare facilities who require specific nutritional interventions as part of their treatment.
03
- Individuals with medical conditions such as diabetes, heart disease, kidney disease, or gastrointestinal disorders that require dietary management.
04
- People seeking weight loss or weight gain through a controlled and balanced diet plan.
05
- Athletes or individuals with specific dietary requirements for performance enhancement or muscle building.
06
- Individuals with food allergies, intolerances, or sensitivities who need a tailored diet plan to avoid triggering allergic reactions or other adverse effects.
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A diet order is a medical prescription that specifies the dietary requirements for a patient.
Registered dietitians or healthcare providers are required to file diet orders for their patients.
Diet orders can be filled out by providing detailed information about the patient's dietary needs and restrictions.
The purpose of a diet order is to ensure that a patient receives the appropriate nutrition based on their medical condition.
Information such as the patient's name, dietary restrictions, recommended food items, and duration of the diet must be reported on a diet order.
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