Get Food/beverage Substitution Request Form - Schools.utah.gov - Schools Utah

Filling out the Food/Beverage Substitution Request Form is an important step in ensuring that children receive appropriate dietary accommodations based on their needs. This guide will provide step-by-step instructions to help you accurately complete the form and submit it with confidence.

Follow the steps to complete the Food/Beverage Substitution Request Form effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your chosen document editor.
2. In the first section, provide the name of the child as it appears on official documents.
3. Next, enter the name of the parent or guardian responsible for this request.
4. Include a valid telephone number where the parent or guardian can be reached for follow-up.
5. List the specific food or beverage that needs to be omitted due to the child's health needs.
6. Indicate the food or beverage that will serve as a suitable substitute.
7. In the diagnosis section, specify any known medical conditions related to the food intolerance or allergy.
8. Describe any symptoms that occur when the omitted food or beverage is consumed, selecting from the options provided or writing additional symptoms as necessary.
9. Assess and select the severity of the symptoms experienced, choosing from mild, moderate, or severe.
10. In the general comments section, provide any additional relevant information that may assist in the child's dietary accommodations.
11. Complete the required section by a licensed physician, confirming whether the child has a disability or not. The physician must also sign and provide their title and contact number.
12. Include the date of signing by the medical authority.
13. The parent or guardian must then sign, giving permission for necessary discussions regarding the child's dietary needs.
14. Once all fields are filled out, do not forget to review the form for accuracy. You may save changes, download, print, or share the completed form as needed.

Ensure you complete and submit the Food/Beverage Substitution Request Form online to facilitate necessary dietary accommodations.