Diet modifications will be accommodated for students who are defined with a disability as stated in Section 504 of the Rehabilitation Act of 1973, Americans with Disabilities Act of 1990 and Part B of the Individuals with Disabilities Education Act and those who have an Individualized Education Program (IEP).
If the physician has recommended diet modifications, have the physician complete and submit the Physician’s Request for Diet Modifications 2019-2020 Form I, to the Child Nutrition Office.
The form must include:
Disability or diagnosis requiring special diet
Foods not allowed and foods allowed
Signature of a physician licensed to practice in the United States. Signatures from
physicians outside of the U. S. (i.e. Mexico), will not be accepted in accordance with USDA Child Nutrition Program regulation.
Until the completed physician’s note is submitted and implemented, the responsibility for feeding the child with special dietary needs will lie with the parents/guardians.
When the modifications are no longer necessary, the parent/guardian can sign, date, and submit the Continue/Remove/Add Form #2 document to remove the modifications from the student’s diet. The modifications cannot be changed prior to receiving the updated documentation.
All completed forms may be returned to the Cafeteria Manager, School Nurse ,
email firstname.lastname@example.org or Fax to (956)427-3944 Attention Dietitian.