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SCHOOL DIET MANAGEMENT PLAN. This form can be added to your IEP for your childs diet needs at school. Section 504 of the Rehabilitation Act of 1973 assures ...

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PWSA (U.S.A.) Page 1PWSA (USA) 5700 Midnight Pass Road Suite 6 Sarasota FL 34242Phone: (800)9264797 (941)3120400 FAX: (914)3120142Email: national@pwsausa.org Website: www.pwsausa.orgU.S.A.PWSA (U.S.A.) PraderWilli Syndrome Association (USA) Inc SCHOOL DIET MANAGEMENT PLAN This form can be added to your IEP for your childs diet needs at school. Section 504 of the Rehabilitation Act of 1973 assures that students with special needs will have access to school meal service even if meal adaptations are needed because of their medical condition. 1. Name of student for whom special meal plan is required:_________________________________ ____________2. Medical condition that requires the student to have a special meal plan: __________________________________________ ______________ 3. *Foods and amounts prescribed (Ex. Serving size calories lowfat etc) Breakfast_________________________________ _________________ Lunch_____________________________________ ________________ 4. *Specific snacks and classroom treats allowed (Ex. Classroom parties outings crafts using food field trips rewards) __________________________________________ _________________________ 5. *School plan required to prevent acquisition of nonprescribed food (Ex.Supervision monitoring peer support shadowing. etc.) __________________________________________ _________________________ 6. *Additional information: __________________________________________ _________________________ __________________________________________ _________________________ I certify that the above named student requires a special diet management plan as described above because of the students disability or chronic medical condition. ____________________________ _______________________________ Physicians Signature Dietitian/Nutritionist Signature____________________________ _______________________________ Address Address ____________________________ _______________________________ ____________________________ ____ ...

Source: www.pwsausa.org

 

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PWSA (U.S.A.)

Filed under: Health and Diet
SCHOOL DIET MANAGEMENT PLAN. This form can be added to your IEP for your childs diet needs at school. Section 504 of the Rehabilitation Act of 1973 assures ...