School Wellness Policy Assessment Tool 2017 - 2018
Special Diet Request Form Instructions
PSJA ISD CHILD NUTRITION PROGRAM (CNP) INSTRUCTIONS FOR SPECIAL DIETS
IMPORTANT THINGS TO KNOW
- Special Diet request will be reviewed by the Registered Dietitian/Nutritionist.
- Acco mmodations will be processed by the Registered Dietitian/Nutritionist utilizing Federal and State guidelines.
- The CNP staff will make every attempt to REASONABLY accommodate students that have dietary restrict ions that are not life threatening or reported by a physician as a disability.
- Special Diet Forms MUST be completed by license physician/med ical authority (physician, physician's assistant, or nurse practitioner) .
- Notes, letters, or diet instructions written on prescription pads will NOT be accepted.
- A new form must be completed each school year. Once a form is received, a staff member will contact the parent/guardian to confirm receipt.
- It can take up to 2 weeks to implement. However, at the beginning of the school year the Special Diet Forms may take longer to process and implement due to the high number of requests that we receive during this time. While the CNP is processing the Special Diet Forms, the parents of the student are responsible for providing the special diet items needed.
- It is the parent/guardian’s responsibility to notify the CNP if any changes occur or if the student transfers to another school.
- The CNP Dietitian/Nutritionist processing the request has the right to contact the medical authority to ask questions or clarify the information on the form.
- If changes/additional restrictions need to be made or if the diet orders need to be discontinued/stopped, a new form must be completed by a licensed physician/medical authority (physician, physician's assistant, or nurse practitioner) and turned into the Campus Nurse or CNP.
INSTRUCTIONS FOR COMPLETING SPECIAL DIET FORM
- Take form to licensed physician/medical authority to be completed
- Once completed, the form can be turned into the campus nurse or faxed to the CNP at (956)354-3044 .
- The CNP Registered Dietitian/Nutritionist will contact you to confirm receipt and may also contact the medical authority with questions or to clarify the orders.
- If the diet changes or needs to be modified throughout the year, a new form must be completed.
- If the student no longer requires the dietary modification a new Special Diet Form must be completed and returned to the campus nurse or faxed to the CNP (there is a box to discontinue on the form).
- All forms and information regarding special diets can be found on the CNP website at http://www.psjaisd.us or if you have any questions, please call the CNP at (956) 784-8545 .
- Return form to Campus Nurse or fax to 956-354-3044
PSJA ISD CHILD NUTRITION PROGRAM 800 S. STEWART RD.
SAN JUAN, TEXAS 78589 PHONE: (956) 784-8545
FAX: (956) 354-3044
Procedures When Unable to Accommodate A Special Diet Request
CHILD NUTRITION PROGRAM
PROCEDURES WHEN UNABLE TO ACCOMMODATE A SPECIAL DIET REQUEST
If the Child Nutrition Program (CNP) is unable to accommodate a student with a special diet request, the following procedures will be followed:
- The dietitian/menu planner will communicate with the student’s parent(s) and the school nurse to explain why the CNP is unable to fulfill the special diet request.
- The dietitian/menu planner will document the reason(s) for not fulfilling the special diet request on the Special Diet Form.
The health and well-being of all students at PSJA ISD is very important.