Idaho schools, child care centers and other Child Nutrition Program sites use this statement when a student or participant needs a special meal or accommodation because of a medical condition or disability. The medical authority describes the impairment and the major life activity it limits, the diet prescription, texture, foods to omit with alternatives, and any adaptive equipment.
A licensed physician, physician assistant, nurse practitioner, naturopathic medical doctor or dentist signs line 14, and for CACFP, NSLP and SBP a registered dietitian may sign. The parent or guardian fills in lines 1 to 6 and signs lines 18 to 21.
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CNP Medical Statement Form
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Yes. The form lists a licensed physician, physician assistant, nurse practitioner, naturopathic medical doctor or dentist as the medical authorities who may sign line 14. For the CACFP, the National School Lunch Program and the School Breakfast Program, a registered dietitian may also sign.
Line 9 describes the specific diet or accommodation in enough detail for staff to carry it out, for example that all foods must be liquid or pureed and the child cannot eat solids. Lines 11 and 12 then list foods to omit, such as fluid milk, and alternatives, such as lactose-reduced or soy milk.