Missouri schools in the National School Lunch and School Breakfast Programs use this DESE statement when a student's disability or medical condition requires a meal modification, such as an allergy diet, a food substitution or a texture change. Federal rules, 7 CFR 210.10(m) and Section 504, require schools to accommodate disability-related diets, and this form documents the clinician's order.
A state-licensed healthcare professional, such as a physician, PA or APRN, or a registered dietitian completes the impairment or diagnosis, foods to omit and substitute, texture changes and signature. The parent supplies the student's details.
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Medical Statement for Student Requiring Meal Modification
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The statement is completed and signed by a state-licensed healthcare professional, such as a physician, physician assistant or advanced practice registered nurse, or by a registered dietitian. The parent then returns it to the school food service director, who uses it to plan the student's modified meals.
No. This DESE form is for students in the school meal programs, the National School Lunch Program and the School Breakfast Program. Child care centers and homes in Missouri's Child and Adult Care Food Program are overseen by the Department of Health and Senior Services instead.