Get the free Special Diet Prescription Form - Bremerton School District

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Bremerton School District Child Nutrition ServicesDiet Prescription for Meals at School the section below must be completed by PARENT / GUARDIAN: students Name:___Date of Birth:___Name of School:___Grade:___Age:___Does

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How to fill out special diet prescription form

01

Obtain the special diet prescription form from your healthcare provider or dietitian.

02

Fill out your personal information including name, date of birth, address, and contact information.

03

Specify the type of special diet you require (e.g. gluten-free, diabetic, low sodium).

04

Provide details about any food allergies or intolerances you have.

05

Indicate any specific dietary restrictions or preferences you want to be taken into consideration.

06

Sign and date the form to confirm your consent and understanding of the information provided.

Who needs special diet prescription form?

01

Individuals who have specific medical conditions that require a special diet, such as diabetes, celiac disease, food allergies, or other dietary restrictions.

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What is special diet prescription form?

Special diet prescription form is a document that allows individuals to request specific dietary requirements or restrictions based on their medical needs.

Who is required to file special diet prescription form?

Individuals with medical conditions or dietary restrictions that require specific accommodations are required to file special diet prescription form.

How to fill out special diet prescription form?

Special diet prescription form can be filled out by providing personal information, medical history, dietary requirements, and physician's recommendation.

What is the purpose of special diet prescription form?

The purpose of special diet prescription form is to ensure that individuals with medical conditions receive appropriate dietary accommodations to support their health and well-being.

What information must be reported on special diet prescription form?

Special diet prescription form must include personal details, medical history, specific dietary requirements, and physician's recommendation.

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