Follow the steps to fill out the form correctly

1. Press the ‘Get Form’ button to access the form electronically and open it in your preferred editing tool.
2. Begin with Part A. Complete the student, parent/guardian, and school contact information. Include the student’s name, date of birth, parent/guardian’s name, and contact details as well as the name and phone number of the school contact.
3. Proceed to Part B, which needs to be completed by a licensed medical authority. Select one of the three modification categories: disability, food allergy/intolerance, or fluid cow's milk substitution. Ensure you provide specific details related to the student's condition.
4. If the modification is due to a disability, indicate what major life activity is affected and specify the type of special diet required. If applicable, also list any modified textures or thicknesses needed for food or liquids.
5. In Part B, include any special feeding equipment required and specify foods that need to be omitted or substituted. Be mindful to note that specific non-dairy beverages must meet federal regulations if substitutions are made.
6. Next, complete Part C to grant permission for school personnel to discuss and implement the prescribed diet order. Ensure that the parent/guardian’s signature and date are provided.
7. If applicable, fill out Part D to request a substitution for fluid cow’s milk. Indicate the substitute being requested and include the parent/guardian’s signature and date.
8. Once all sections are complete, review the entire form for accuracy. Make any necessary edits before finalizing.
9. Finally, save your changes. You can choose to download, print, or share the completed form as needed.

Take a moment to complete the KS Medical Statement To Request School Meal Modification online to ensure your child's dietary needs are met.