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This form is used to request special meals or accommodations for students with disabilities or medical conditions requiring dietary modifications, and must be signed by a licensed medical authority.
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How to fill out medical statement to request
How to fill out Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions
01
Obtain the Medical Statement form from your school or healthcare provider.
02
Fill in the participant's name and date of birth at the top of the form.
03
Have a licensed healthcare professional complete the required sections, detailing the medical condition and specific dietary needs.
04
Include any necessary accommodations for special meals, such as food allergies or intolerances.
05
Provide a clear indication of milk substitutions or alternatives needed.
06
Ensure the healthcare professional signs and dates the form.
07
Submit the completed form to the appropriate school or dietary services office.
Who needs Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions?
01
Students with food allergies or intolerances.
02
Children who require special diets for medical reasons.
03
Individuals who need milk substitutions due to lactose intolerance or other conditions.
04
Students with specific dietary restrictions related to health or religious beliefs.
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What do you write in dietary requirements?
What are the common special dietary requirements? Gluten free and coeliac. Dairy free and lactose free. Vegetarian. Vegan. Paleo. FODMAP. Tree nut and peanut allergies. Fish and shellfish allergies.
What is the medical term for special diet?
A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. It is part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician. A therapeutic diet is usually a modification of a regular diet.
What is special food for medical purposes?
These foods are intended for the exclusive or partial feeding of people whose nutritional requirements cannot be met by normal foods. The Directive 1999/21/EC lays down essential requirements on their composition and gives guidance for the minimum and maximum levels of vitamins and minerals.
What is the medical statement for special dietary needs?
The licensed medical practitioner's statement must identify: • an explanation of how the child's physical or mental impairment restricts the child's diet; • the food(s) to be avoided; and • the food or choice of foods that must be substituted.
What is a medical statement for special dietary needs?
The licensed medical practitioner's statement must identify: • an explanation of how the child's physical or mental impairment restricts the child's diet; • the food(s) to be avoided; and • the food or choice of foods that must be substituted.
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What is Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions?
A Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions is a formal document used to notify school or childcare facilities of a student's dietary restrictions or special meal needs due to medical conditions.
Who is required to file Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions?
Parents or guardians of students with specific dietary restrictions or medical conditions that require changes in meal accommodations must file the Medical Statement.
How to fill out Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions?
To fill out the Medical Statement, the parent or guardian should provide personal details of the child, describe the medical condition, specify the required meal modifications, and obtain a signature from a licensed medical professional.
What is the purpose of Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions?
The purpose of the Medical Statement is to ensure that students with medical conditions receive appropriate meals that meet their dietary needs and to comply with regulations regarding food safety and nutrition.
What information must be reported on Medical Statement to Request Special Meals, Accommodations, and Milk Substitutions?
The information that must be reported includes the child’s name, the medical condition, the required dietary modifications, any specific foods to avoid, and the medical professional's contact information.
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