Special Diets in School Nutrition Programs

Medical Statements


Medical Statement for Disability Reasons  |   Required Elements
Authorized Signers  |   Medical Statement for Non-disability Reasons
Medical Statement Forms


Medical Statement for Disability Reasons

The U.S. Department of Agriculture (USDA) requires a medical statement signed by a state licensed healthcare professional or registered dietitian when the requested modification is outside the meal pattern requirements for the school nutrition programs [7 CFR 210.10(m)(1)(i), 220.8(m) and 7 CFR 220.8(m)]. School food authorities (SFAs) may choose to require a written medical statement for disability meal modifications within the meal pattern requirements. SFAs should consider the burden of requiring medical statements and must inform parents, guardians, and their children, if age appropriate, of the process for requesting meal modifications [7 CFR 210.10(m)(1)(ii), 220.8(m)].

Required Elements

The medical statement must include the three elements below.

  1. Information about the child's disability that allows the SFA to understand how the disability restricts the child's diet.
  2. An explanation of how to accommodate the child's disability.
  3. For modified meals, the food or foods that must not be served and the recommended alternatives.

Medical statements should provide sufficient information to allow SFAs to provide meals that are appropriate and safe for each child and comply with the USDA’s requirements. If the medical statement is unclear or lacks sufficient detail, the SFA should work with the child’s parent/guardian to obtain an amended medical statement. While awaiting additional information, the SFA should follow the clear and unambiguous sections of the medical statement to the greatest extent possible. Clarification of the medical statement should not delay the SFA from providing a reasonable meal modification for the child. For additional guidance, refer to "Medical Statement Requirements" in section 2 of the CSDE's Guide to Meal Modifications in School Nutrition Programs.

Medical Statement for Non-disability Reasons

The USDA does not require a medical statement for meal modifications within the meal patterns, such as texture modifications or substitutions within the same meal component, e.g., banana for strawberries (fruits component), lactose-free milk for regular milk (milk component), and chicken for pork (meats/meat alternates component). However, local educational agencies (LEAs) may apply stricter guidelines and require that SFAs keep a medical statement on file concerning the needed modifications. SFAs may use the CSDE's medical statement form for this purpose (refer to "Medical Statement Forms" below).

Meal modifications for non-disability reasons that are outside the meal patterns require a medical statement signed by a state licensed healthcare professional or registered dietitian.

Authorized Signers

State licensed healthcare professionals and registered dietitians may write medical statements to request meal modifications on behalf of children with disabilities in the school nutrition programs [7 CFR 210.10(m)(1)(i))]. SFAs must implement the requirement to accept medical statements from registered dietitians by July 1, 2025, as required by the USDA final rule, Child Nutrition Programs: Meal Patterns Consistent with the 2020-2025 Dietary Guidelines for Americans. SFAs may choose to implement this change prior to this deadline.

Medical Statement Forms

The CSDE’s medical statement form includes the USDA required elements indicated above. SFAs may use any alternate form that includes the three required elements (refer to "Required Elements" above). To protect children’s privacy and confidentiality, the medical statement cannot require a specific diagnosis by name or use the terms “disabled” or “disability.”

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