SPECIAL DIETARY NEEDS MEDICAL STATEMENTS

 

Forms are in ADOBE files.

On a case by case basis, a student with disabilities shall be provided substitutions in foods only when supported by a statement signed by a S.C. licensed physician.  Federal regulations require the school to receive written instruction from the appropriate medical authority before the school can modify meals.

 

Medical Statement for students with Disabilities   

Please print both pages below:                                                                    

 page 1  page 2

Both page 1 and 2  must be completed and signed.
Schools may make substitutions for individual students who are not disabled persons but who are unable to consume a food item because of medical or other special dietary needs.  Such substitutions may only be made on a case by case basis when supported by a statement signed by a recognized medical authority.  In these cases the recognized medical authority may a physician, a physician's assistant or a nurse practitioner.

Medical Statement for Students with Food Allergies or Food Intolerance

Please print both pages below:

page 1   page 2

Both page 1 and 2  must be completed and signed.

 

These Forms MUST be signed by the Parent or Guardian as well as by the Medical Authority.