South Dakota's Child and Adult Nutrition Services uses one request for meal modifications in schools, child care centers and homes, and adult day care. When Part B box A is checked, the participant has a condition that limits a major life activity and the program operator wants a medical statement, so the clinician completes Part C (how the diet is restricted, foods to avoid, substitutions, texture and liquid consistency) and signs Part D.
The parent, guardian or participant completes Part A and, with the program operator, Part B. A licensed MD, DO, PA, NP, CNP, CNM or registered dietitian completes Part C and signs items 16 to 18 when box A is checked; the parent signs items 19 to 21.
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Meal Modification Request
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When box A in Part B is checked: the participant has a condition that limits a major life activity and the program operator asks for a medical statement. A licensed MD, DO, PA, NP, CNP, CNM or registered dietitian then completes Part C and signs Part D. Box B requests met within the meal pattern need no signature.
No. The instructions say medical statements do not need to be updated on a regular basis, though parents are encouraged to review the request each year. The school or agency follows the modification until a parent or recognized medical authority provides a signed statement that it is no longer needed.
Yes. South Dakota's Child and Adult Nutrition Services posts translated Meal Change forms in Spanish, German and Karen alongside the English Meal Modification Request, a four-page PDF that includes the instructions and the definition of a recognized medical authority.