Get Ospi Child Nutrition Program Dietary Prescription Form

Completing the Ospi Child Nutrition Program Dietary Prescription Form online is essential for ensuring that students with disabilities receive appropriate dietary accommodations. This guide will walk you through each section of the form to simplify the process and ensure accuracy.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and access it in your editor.
2. Begin by filling in the parent/guardian section. Enter the student’s name, birth date, age, and grade. Ensure that you provide the parent or guardian's name, phone number, and mailing address, including city, state, and zip code. Don’t forget to sign and date the section to validate your submission.
3. In the next section, which must be completed and signed by a licensed physician, list the student’s disability. Include any life-threatening allergies that cause an immune system response to specific foods, ingredients, or additives.
4. Identify the major life activities affected by the student’s disability. This will help in understanding the required dietary modifications.
5. Describe how the disability affects the student's diet in the next section. Be specific about the restrictions to make it clear for the dietary accommodations needed.
6. List all foods and/or milk that must be omitted from the student's diet to accommodate their needs.
7. Detail any foods and/or milk that should be substituted to ensure the student has suitable alternatives.
8. Indicate any foods that require texture modifications. Explain how to prepare these foods, such as chopping, grinding fine, or pureeing.
9. Include any additional comments regarding the student's eating or feeding patterns to provide further context.
10. Finally, ensure the licensed physician’s signature, printed name, date, email, phone number, and address are entered to finalize this section of the form.
11. Review all entries for accuracy, then save your changes, and choose to download, print, or share the completed form as needed.

Complete the Ospi Child Nutrition Program Dietary Prescription Form online today to ensure your student receives the necessary dietary accommodations.