Meal Pattern Minute: Medical Statements

Dietary meal modification requests are no stranger to Child and Adult Care Food Program operators. Many times, these food alterations are asked by the parent or guardian either with a parent note or verbally. However, when you have an individual who has a disability, medical condition, or special dietary need that requires meal accommodations, a medical statement is needed. This makes sure you are serving safe food to those in your care. When making a request for a medical statement it is important to know what a medical statement is, when to ask for one, who can write it, and what information needs to be in it. 

Get this information in under a minute with Isabel Ramos-Lebron, MS, RDN, LDN, where she discusses what a medical statement is in this Meal Pattern Minute. 

Watched the video but looking for more information? Below are some additional resources that you can access to help request medical statements and understand what should be on the form. 

Modifications to Accommodate Disabilities in  CACFP and SFSP 

• Program regulations require Program operators to provide modifications for participants with disabilities on a case-by-case basis only when requests are supported by a written statement from a State licensed healthcare professional, such as a physician or nurse practitioner (medical statement). (See 7 CFR 226.20(g), and 225.16(f)(4).) Meals that do not meet the Program meal pattern requirements are not eligible for reimbursement unless supported by a medical statement. However, Program operators may choose to accommodate requests related to a disability that are not supported by a medical statement if the requested modifications can be accomplished within the Program meal pattern. Such meals are reimbursable.
•  The medical statement should include a description of the participant’s physical or mental impairment that is sufficient to allow the Program operator to understand how it restricts the participant’s diet. It should also include an explanation of what must be done to accommodate the disability. In the case of food allergies, this means identifying the food or foods that need to be omitted and recommending alternatives. In other cases, more information may be required. For example, if an infant requires the substitution of a Food and Drug Administration exempt infant formula in place of iron-fortified infant formula to accommodate a disability, this information must be included in the statement.
•  When Program operators believe the medical statement is unclear, or lacks sufficient detail, they must obtain appropriate clarification so that a proper and safe meal can be provided. Program operators may consider using the services of a Registered Dietitian, when available, to assist in implementing meal modifications, as appropriate. Program operators may also contact their State administering agency for guidance.

Frequently Asked Questions about Fluid Milk and Medical Statements 

• Meal Pattern Minute: Medical Statements with Soy Milk
• Meal Pattern Minute: Almond Milk as a Fluid Milk Substitute

Webinars 

• Understanding Meal Modifications in the CACFP
  • Have you ever received a parent’s or doctor’s note describing a meal modification or substitution to serve a child in your care? Maybe you have felt confused or overwhelmed on how to modify the menu to ensure foods are safe to serve to a participant with a disability. Learn about the requirements for having a medical statement to serve safe and reimbursable foods in the CACFP. Identify creditable and non-creditable milk substitutions in the CACFP and understand the documentation needed. Gain valuable knowledge on tailoring foods for special diets, including vegetarian, pureed, and gluten-free diets. Empower yourself with the information and guidance to confidently address meal modifications and provide suitable options for participants with specific dietary needs in the CACFP at your Head Start site. 
    
• Accommodating Participants with Disabilities in Community Meals
  • Have you ever received a parent’s or doctor’s note describing a meal modification or substitution to serve a child in your care? Maybe you have felt confused or overwhelmed on how to modify the menu to ensure foods are safe to serve to a participant with a disability. Learn about the requirements for having a medical statement to serve safe and reimbursable foods in the CACFP. Identify creditable and non-creditable milk substitutions in the CACFP and understand the documentation needed. Gain valuable knowledge on tailoring foods for special diets, including vegetarian, pureed, and gluten-free diets. Empower yourself with the information and guidance to confidently address meal modifications and provide suitable options for participants with specific dietary needs in the CACFP at your Head Start site.
  • Presented by USDA Food and Nutrition Services. Get requirement updates related to accommodating participants with disabilities participating in CACFP/SFSP, as required by Federal law, USDA regulations and the Policy Memorandum, Modifications to Accommodate Disabilities in the Child and Adult Care Food Program and Summer Food Service Program to ensure equal access and opportunity.

NCA Member Resource: Accommodating Special Diets in the CACFP Flow Chart 

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