• Medical Statement for Student with Special Dietary Needs Due to Disability: If the student has a disability that affects his/her diet, a licensed physician must complete this form.
• Medical Statement for Statement with Special Dietary Needs Due to Food Allergy or Intolerance:If the student has a food allergy or intolerance, a physician or other recognized medical authority (i.e. physician's assistant or nurse practitioner) must complete this form.
• If there are no changes in a previously approved special diet, only the signature of the parent/guardian is required on the appropriate form.
• Any change in diet must be supported by the written instructions and the signature of the appropriate medical authority.

The medical authority must list on the form all foods that are to be eliminated from the diet and foods that may be substituted. 

Parents/guardians are responsible for providing safe and appropriate food until they are notified in writing that the special diet has begun.

The appropriate medical statement should be dated no earlier than July 1, 2008, for school year 2008-2009.  The completed medical statement should be returned as soon as possible to:  Nutrition Services, 3850 N. Hydraulic, Wichita, KS, 67219.  If you have questions or need assistance, please call Chris Brandorff at 973-2178. 

If a special diet is to be discontinued, the Discontinuation of Diet Instructions for Allergies, Intolerances or Disabilities form must be completed and returned to:  Nutrition Services, 3850 N. Hydraulic, Wichita, KS, 67219.

Helpful Information

• Special Diet Reminders
Special Diet Descriptions
• Modified Texture Diet Descriptions