Medical statement to request special meals andor accommodations cnp 925 form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'School/Agency' field with the name of the institution providing this form.
3. Next, enter the 'Site' where meals will be served, such as a school or community center.
4. Provide the 'Site Telephone Number' for any inquiries regarding meal services.
5. Fill in the 'Name of Participant' with the individual who requires special meals or accommodations.
6. Indicate the participant's age or date of birth in the corresponding field.
7. Enter the 'Name of Parent or Guardian' requesting this medical statement along with their telephone number.
8. Check one box to indicate if the participant has a disability requiring special meals or if they have food intolerances.
9. Describe any disability or medical condition that necessitates a special meal in detail.
10. If applicable, provide a brief description of how the disability affects major life activities.
11. Detail any diet prescriptions or accommodations needed for proper implementation.
12. Select the required food texture from options like Regular, Chopped, Ground, or Pureed.
13. List specific foods to be omitted and suggested substitutions to ensure dietary needs are met.
14. Mention any adaptive equipment necessary for dining assistance.
15. Sign and print your name as the preparer of this form, including your contact information and date.
16. Ensure a licensed medical authority signs and provides their details at the end of the form for validation.

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