Sample medical statements for food substitutions or modifying meals
Medical Statement for Students Requiring Special Meals and/or Accommodations Form
Medical Statement for Students Requiring Special Meals Form
Note: Families may also obtain a detailed letter from the student’s physician identifying all of the items below.
United States Department of Agriculture (USDA) Regulations
For schools participating in a federally-funded school nutrition program, USDA regulations 7 CFR Part 15b require substitutions or modifications in school meals for students whose disabilities restrict their diets. A student with a disability or medical condition must be provided substitutions in foods when that need is supported by a statement signed by a licensed physician. A physician is a person licensed by the State to practice medicine. The term includes physicians or doctors of osteopathic medicine. These fully trained physicians are licensed by the State to prescribe medication or to perform surgery. The physician’s statement must identify:
a. The student’s disability or medical condition
b. An explanation of why the disability restricts the student’s diet
c. The major life-activity affected by the disability
d. List the food or foods to be omitted from the student’s diet
e. List the food or choice of foods that must be substituted
Definitions1
USDA FNS Instruction 783-2, 7 CFR Part 15b
Disability: Under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act, ”person with a disability” means any person who has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment.
“Physical or mental impairment:” means (1) any physiological disorder or condition, cosmetic disfiguration or anatomical loss affecting one or more of the following body systems: Neurological, musculoskeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic skin and endocrine; or (2) any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities. The term “physical or mental impairment“ includes, but is not limited to, such diseases and conditions as orthopedic, visual, speech, and hearing impairments; cerebral palsy; epilepsy; muscular dystrophy; multiple sclerosis; cancer; heart disease; metabolic diseases such as diabetes and phenylketonuria (PKU); food anaphylaxis; mental retardation; emotional illness; and drug addiction and alcoholism.
Major life activities: are defined as caring for one’s self, eating, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working.
USDA regulations have not been amended to reflect the ADA Amendments Act. Regulation will be updated by Department of Agriculture ( 196 section 131).
1 USDA Accommodating Children with Special Dietary Needs in the School Nutrition Programs, fns.usda.gov/cnd/guidance/special_dietary_needs.pdf