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Brunswick CountySchools DIET ORDER/ MEDICAL STATEMENT SEND COMPLETED FORM TO: The SCHOOL NURSE OR BCS CHILD NUTRITION DEPT. 35 Referendum Drive, Bolivia, NC 28422 PH: 9102531098 FAX: 9102532876NOTE:
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How to fill out diet order medical statement

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How to fill out diet order medical statement

01
Obtain the diet order medical statement form from the healthcare provider.
02
Fill in the patient's personal information, including name, date of birth, and medical record number.
03
Specify the dietary restrictions or modifications required for the patient.
04
Include any allergies or intolerances the patient may have.
05
Sign and date the form to confirm that the information provided is accurate.

Who needs diet order medical statement?

01
Patients who require specific dietary restrictions or modifications due to medical conditions or allergies.

What is DIET ORDER/ MEDICAL STATEMENT Form?

The DIET ORDER/ MEDICAL STATEMENT is a fillable form in MS Word extension needed to be submitted to the specific address to provide specific information. It has to be completed and signed, which is possible manually in hard copy, or by using a particular software like PDFfiller. This tool helps to fill out any PDF or Word document directly from your browser (no software requred), customize it according to your purposes and put a legally-binding electronic signature. Once after completion, the user can send the DIET ORDER/ MEDICAL STATEMENT to the appropriate recipient, or multiple ones via email or fax. The editable template is printable as well thanks to PDFfiller feature and options presented for printing out adjustment. Both in electronic and in hard copy, your form should have a neat and professional appearance. Also you can turn it into a template for further use, so you don't need to create a new blank form from the beginning. Just customize the ready template.

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The diet order medical statement is a formal document issued by healthcare providers that outlines specific dietary requirements for patients based on their medical condition.
Healthcare providers, including doctors and dietitians, are required to file the diet order medical statement for patients who need dietary modifications for health reasons.
To fill out a diet order medical statement, provide patient information, specify the medical condition, outline the recommended diet, and include any additional dietary restrictions or considerations.
The purpose of the diet order medical statement is to ensure that patients receive appropriate nutritional support and dietary modifications to aid in their treatment and recovery.
The information that must be reported includes patient identification details, diagnosis, specific dietary recommendations, duration of the diet order, and the signature of the healthcare provider.
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