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May 20 2012
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    Special Dietary Needs - Forms  
      Name
    PDF Documents SPECIAL DIETARY NEEDS FORM
    PDF Documents SPECIAL DIETARY NEEDS FORM IN SPANISH
    Special Dietary Needs
    Physician’s Statement for Children with Disabilities and Special Dietary Needs

    USDA regulations 7 CFR Part 15b require substitutions or special dietary accommodations in school meals for children whose disabilities restrict their diets. A child with a disability must be provided substitutions in foods when that need is supported by a statement signed by a licensed physician. The physician’s statement must identify:
    • Child’s disability
    • Major life activity affected by the disability
    • Food or foods to be omitted from the child’s diet
    • Food or foods that must be substituted
    The MPS SPECIAL DIETARY NEEDS: EATING AND FEEDING EVALUATION form is adapted from the USDA guidance: Accommodating Children with Special Needs: Guidance for School Food Service Staff, and may be used to obtain the required information from the physician and/or medical authority (see reference below).

    Managing Severe/Life Threatening Food Allergies with Anaphylactic Reactions

    If the physician’s assessment indicates that the food allergy may result in severe, lifethreatening (anaphylactic) reactions, the child’s condition would meet the definition of a “disability.” In such cases, the prescribed substitutions by the licensed physician must be made. In addition, a licensed physician must then sign the MPS SPECIAL DIETARY NEEDS: EATING AND FEEDING EVALUATION form (yellow section).

    Managing (Non-severe) Food Allergies and/or Food Intolerances

    The school food service authority is not required to make food substitutions for children with non-severe food allergies or food intolerances, who do not have a disability as defined under either Section 504 of the Rehabilitation Act or Part B of IDEA.

    The school food service authority may choose to make food substitutions, at their discretion, for individual children who do not have a disability, but who are medically certified as having a special medical or dietary need. Determinations are made on a case-by-case basis. This provision covers those children who have food intolerances or allergies but do not have lifethreatening reactions. In this case, a Medical Authority (other than a licensed Physician) can complete and sign the MPS SPECIAL DIETARY NEEDS: EATING AND FEEDING EVALUATION form. The completed and signed form must be sent to the School Nutrition Services department.

    Other Special Dietary Needs (Religious Restrictions)

    If there is no known allergy, food intolerance or disability, but the parent requests that a specific food be eliminated for religious reasons, the school food service authority may choose, at their discretion, to make a food substitution, but is not required to provide a substitution. In this case, the parent may complete, sign and return the form to the food service manager.

    *Reference: Accommodating Children with Special Needs: Guidance for School Foods Service Staff, United States Department of Food and Nutrition Service, Fall 2001. http://www.fns.usda.gov/cnd/Guidance/default.htm
    MPS Non-Discrimination Notice
    Nondiscrimination Notice

    It is the policy of the Milwaukee Public Schools, as required by section 118.13, Wisconsin Statutes, that no person will be denied admission to any public school or be denied the benefits of, or be discriminated against in any curricular, extracurricular, pupil services, recreational or other program or activity because of the person�s sex, race, color, religion, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional or learning disability.

    This policy also prohibits discrimination under related federal statutes, including Title VI of the Civil Rights Act of 1964 (race, color, and national origin), Title IX of the Education Amendments of 1972 (sex), and Section 504 of the Rehabilitation Act of 1973 (disability), and the Americans with Disabilities Act of 1990 (disability).

    The following individuals have been designated to handle inquiries regarding the non-discrimination policies:

    • For section 118.13, Wisconsin Statutes, federal Title IX:
      Patricia Gill, Director, Office of Family Services, Room 133, Milwaukee Public Schools,
      5225 West Vliet St., P. O. Box 2181, Milwaukee, Wisconsin, 53201-2181
    • For Section 504 of the Rehabilitation Act of 1973 (Section 504), federal Title II:
      Jeff Molter, 504/ADA Coordinator for Students, MPS Department of Special Services,
      5225 West Vliet St., P. O. Box 2181, Milwaukee, Wisconsin, 53201-2181. (414) 475-8139 TTD: (414) 475-8139