Medical Statement for Students with Unique Mealtime Needs for School Meals

Meal Substitutions for Medical or Special Dietary Reasons 

USDA Regulation 7 CFR Part 15b requires substitutions or modifications in school meals for children whose disabilities restrict their diets. A child with a disability must be provided substitutions in foods when that need is supported by a signed statement from a licensed physician.

In Cases of Food Allergy

Generally, children with food allergies or intolerance do not have a disability as defined under either Section 504 of the Rehabilitation Act or Part B of IDEA, and the school food service may, but is not required to, make food substitutions for them.  However, when in the licensed physician’s assessment, food allergies may result in severe, life-threatening (anaphylactic) reactions, the child’s condition would meet the definition of “disability”, and the substitutions prescribed by the licensed physician must be made.

School food service may make food substitutions/reasonable accommodations, at their discretion, for individual children who do not have a disability, but who are medically certified as having a special medical or dietary need.  Such determinations are only made on a case-by-case basis.  This provision covers those children who have food intolerance or allergies but do not have life-threatening reactions (anaphylactic reactions) when exposed to the food(s) to which they have problems.

Medical Statement (Diet Order Form) for Children with Special Dietary Needs

Each special dietary request must be supported by a statement explaining the requested food substitution and must be signed by a recognized medical authority. The Medical Statement must include:

• An identification of the medical or other special dietary condition which restricts the child’s diet;
• The food or foods to be omitted from the child’s diet; and
• The food or choice of foods to be substituted.

If we do not receive a medical statement from a recognized medical authority, your child will receive a regular lunch tray.  Medical statements completed by parents or guardians will not be accepted. Special Dietary Needs that are no longer valid also require a medical statement in order to remove them from the student's account. 

Please keep in mind UCPS - School Nutrition Services' is peanut/tree nut sensitive, not peanut/tree nut free. Although a la carte items have been reviewed for peanut and tree nut ingredients, please be aware, some items may be processed in a facility with peanuts and/or tree nuts. This may result in possible cross-contact of peanuts/tree nuts.

NOTE: In the U.S., it is voluntary for a manufacturer to include a statement on their package regarding whether their manufacturing facility also processes any of the top eight allergens. Some manufacturers voluntarily list that certain food allergens are processed on a shared line or in a shared facility, while others don’t list any statement.

If you have any questions, please contact the cafeteria manager. Consult the School Nutrition website to view menu items that have been identified as containing one or more of the 8 major allergens.  

The medical statements below have further guidance on how to properly complete the form as the parent/guardian and medical authority. Please keep in mind whether your student dines with the cafeteria or not and has a unique mealtime need we will need this form completed.  This form is filed at the school (with nurse) and School Nutrition Services Department.

• Medical Statement for students with special nutritional needs for school meals
• Declaracion medical para edstudiantes con necesidades nutricionales especially para comidas escolares