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Medical Statement Requirements

For your convenience, we have included the text from the official PDF document on this page. If you need to view or print the original PDF for your records, you can download it using the link below.

Medical Statement Requirements and Instructions

Medical Statement for Children with Disabilities

USDA regulation 7 CFR Part 15b requires substitutions or modifications in school meals for children whose disabilities restrict their diets. A child with a disability with substitution requests which fall outside of the meal pattern must be supported by a statement signed by a licensed healthcare professional (licensed physician (MD), advanced practice nurse (APN) with prescriptive authority (RXN), or physician assistant (PA)).

If an SFA chooses to use its own medical statement the statement signed by the licensed physician (MD or DO), advanced practice nurse (APN) with prescriptive authority (RXN) or physician assistant (PA), it must include all of the following:

  • The child’s disability and explanation of how the disability restricts the child’s diet
  • Major life activity affected by the disability
  • The food or foods to be omitted from the child’s diet, and the food or choice of foods that must be substituted

According to USDA Memo SP 26-2017, if the child’s Individualized Education Plan (IEP) or 504 Plan includes the same information required in the medical statement or if the required information is obtained by the school during the development or review of the IEP or 504 Plan, it is not necessary for the SFA to obtain a separate medical statement. 

Medical Statement Requirements

In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339.

To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508-0002- 508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by:

  1. Mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; or
  2. Fax: (833) 256-1665 or (202) 690-7442; or
  3. Email: program.intake@usda.gov

This institution is an equal opportunity provider.