CRITERIA AND PROCEDURE
CRITERIA AND PROCEDUREBROAD SUBJECT: Allergies and Special DietsNO: MS-03-05TITLE: Allergies and Special DietsEFFECTIVE DATE:September 16, 2011Revised February 2, 2015PURPOSE OF THIS CRITERIA/PROCEDURE –Under the U.S. Department of Agriculture (USDA) nondiscrimination regulations 7 CFR Part15b, schools are required to serve meals to students with disabilities whose disabilities restricttheir diet in such a way that they cannot fully participate in the school nutrition program withoutsome modification to foods or menus. Schools may make substitutions for students withoutdisabilities because of medical or other special dietary needs. The purpose of thisCriteria/Procedure is to clarify how this regulation shall be implemented.KEY TERMS AND DEFINITIONS –Americans with Disabilities Act of 1990 (ADA): Federal legislation enacted toprotect persons with disabilities from discrimination.Anaphylaxis/anaphylactic reaction: This is a rare but potentially fatal condition inwhich several different parts of the body experience food-allergic reactions at the same time.Symptoms may progress rapidly and include severe itching, hives, sweating, swelling of thethroat, breathing difficulties, lowered blood pressure, unconsciousness and even death.Disability: A physical or mental limitation which substantially limits one or more of the majorlife activities.Food Allergy: Hypersensitivity from an abnormal response of the body’s immune systemto food or food additives that would normally be considered harmless.Food Intolerance: An adverse food-induced reaction that does not involve the body’simmune system.Handicapped person 7 CFR Part 15b: Any person who has a physical or mentalimpairment which substantially limits one or more major life activities, has a record of suchimpairment, or is regarded as having such impairment.Georgia Department of EducationPage 1 of 6 January 2015“USDA is an equal opportunity provider and employer.”
Individual Education Program (IEP): A planning document required annually forspecial education services in public schools serving children older than 3 years of age thatoutlines specific goals, activities, and time lines.Individuals with Disabilities Education Act (IDEA): This act requires service ofmeals even when such service is not required by the Child Nutrition Program.Medical Authority: A medical authority may include physicians, physician assistants, ornurse practitioners.Medical Statement/Diet Prescription: A statement that explains why the student’sdisability restricts the participant’s diet, the major life activity affected by the disability, and thefood or foods to be omitted and/or substituted in the student’s diet. See Example of a MedicalStatement at end of this Criteria and Procedure.Rehabilitation Act of 1973: This act “provides that no otherwise qualified handicappedindividuals shall, solely on the basis of handicap, be excluded from participation in, be deniedbenefit of, or subjected to discrimination under any program or activity receiving Federalfinancial assistance”.Reimbursable Meal: Meals served to eligible recipients under the National School LunchProgram, School Breakfast Program or as an afterschool snack that meet the requirements ofthe meal pattern.Special Dietary Needs: An individual who does not have a disability, as defined in 7 CFRPart 15b, but is unable to consume a particular food because of a medical or other specialdietary condition.CRITERIA AND/OR PROCEDURES –1.The National School Lunch Program must be available to all students, includingstudents with disabilities.2.Federal laws and the regulations for the National School Lunch Program(including after school snacks) and the School Breakfast Program require schoolfood authorities to make accommodations for students who are consideredhandicapped under 7 CFR Part 15b and unable to eat the school meal asprepared because of a disability. (Accommodating Special Dietary Needs in theSchool Nutrition Programs, Part II, Fall 2001).Georgia Department of EducationPage 2 of 6 January 2015“USDA is an equal opportunity provider and employer.”
3.Directors of school food authorities, manager/supervisors, and school foodservice managers should be involved early on in the decisions regarding specialmeals. Managers should work closely with the parent(s) or guardian(s) and withall other school, child care, medical and community personnel who areresponsible for the health, well-being and education of participants withhandicaps or with other special dietary needs to ensure that reasonableaccommodations are made to allow such individuals' participation in the mealservice.4.Directors and manager/supervisors of food authorities must provide informationto physicians, nurses, or parents when the medical statement specifies grams ofcarbohydrate or count grams of carbohydrate in meals to determine insulin dose.5.If school food service employees do not understand the diet prescription for astudent with special dietary needs, they should consult with their supervisor.6.Meal modifications vary depending on the student’s disability. Chewing andswallowing difficulties may require modifications to include softer foods and somefoods may need to be chopped, ground, or pureed. The diet prescription mayrequest smaller or larger portions in order to meet specific needs. Still others mayrequire commercially prepared foods/supplements.7.When modifications are made, all food components must be offered according tothe meal pattern requirements unless prohibited by the medical statement or dietprescription.8.Meals for students with special dietary needs should be prepared, handled, andstored following the same food safety procedures required for all other meals.Children are particularly vulnerable to potential food borne illnesses – especiallychildren with special healthcare needs.9.Substitutions must be made for items in reimbursable meals when the school hasa written statement on file signed by a licensed physician indicating what thestudent’s disability is, what foods must be omitted from the student’s diet, andwhat foods must be substituted.10.Schools are not required, but are encouraged to make substitutions for studentswith special dietary needs that do not meet the definition of disability under theFederal law. Refer to the FNS manual titled Accommodating Special DietaryNeeds in the School Nutrition Programs, Part II, Fall 2001 to determine if a childmeets the definition of disability.Georgia Department of EducationPage 3 of 6 January 2015“USDA is an equal opportunity provider and employer.”
11.A medical statement, completed by a medical authority, ensures that the nutritionintegrity of the school meal will not be compromised by the substitution. Inaddition, it ensures that decisions about specific food substitutes are made byhighly qualified persons. This helps to protect both the student and the foodservice personnel who are working to meet the student’s needs. The attachedmedical statement for meals at schools addresses required componentsdescribed in FNS Instruction 783-2 Rev. 2. If the school/system chooses todesign its own form for documentation, it must address the items listed in theattached statement.12.School food service staffs are not allowed to revise or change a diet prescription.13.A medical statement is not required to be renewed annually. However, schoolsare encouraged to ensure the diet order reflects the current dietary needs of thestudent.14.Parents or guardians may request in writing non-dairy milk substitutions withoutproviding a medical statement. The written request must identify the medical orother special dietary need that restricts the diet of the student. Suchsubstitutions are at the option and the expense of the School Nutrition Program.Refer to Criteria and Procedure MS-03-01 Fluid Milk Substitutions.15.Nutrition disclosures may be required upon request from a physician for certainstudents. This may include providing portion sizes, calories, carbohydrates, fat,and sodium for each menu item. An example would be providing grams ofcarbohydrate per menu item to parents or school nurses for students withdiabetes to determine insulin requirements. Refer to Criteria and ProcedureNSE-05-01 Disclosure of Nutrition Information.16.Meals served outside of the regular meal schedule may not be claimed asprogram meals; however, the location of service may be the food service facilityor food service management company to prepare these meals.While any additional costs for substituted foods are considered allowable childnutrition program costs, no additional program reimbursement is available.17.School Nutrition Program Funds may be used to purchase foods and specialequipment needed to prepare and/or serve food.18.The School Nutrition Program is only responsible for the portion of the foodsupplement which can be identified as a lunch or breakfast. However, the schoolfood service would not be required to pay for other servings through the schoolday unless specified in the diet prescription.19.Reimbursement for meals served with an authorized substitute food to disabledstudents or to students with other special dietary needs shall be claimed at thesame reimbursement rate as meals that meet the meal pattern.Georgia Department of EducationPage 4 of 6 January 2015“USDA is an equal opportunity provider and employer.”
Resources and References –Meeting Children’s Special Food and Nutrition Needs in Child Nutrition Programs, 2006Breakfast Lunch Training (National Food Service Management Institute es/PDF/20080218103653.pdfAccommodating Children with Special Needs in the School Meals Programs, (USDAPublication) http://www.fns.usda.gov/cnd/guidance/special dietary needs.pdfFNS Policy Memorandum SP 07-2010 Q&As: Milk Substitution for Children with Medical orSpecial Dietary Needs (Non-Disability) /2010/SP 07 CACFP 04 SFSP 05-2010 os.pdfFNS Policy Memorandum CACFP 21-2011: Child Nutrition Reauthorization 2010: NutritionRequirements for Fluid Milk and Fluid Milk Substitutions in the Child and Adult Care FoodProgram ymemo/2011/CACFP-21-2011.pdfFNS Policy Memorandum SP 36-2013, CACFP 10-2013, SFSP 12-2013: Guidance Related tothe ADA Amendments Act 013os.pdfAUTHORITY – FEDERALU.S. Department of Agriculture (USDA) nondiscrimination regulations 7 CFR Part 15bRehabilitation Act of 1973, Section 504Code of Federal Regulations, Parts 210.10 (g); 220-8(d)USDA Instruction 783-2 REV 2, Meal Substitutions for Medical or Other Dietary ReasonsAUTHORITY – STATEState Board of Education Rule 160-5-1-.22 PERSONNEL REQUIREDState Board of Education Rule 160-5-6-.01 STATEWIDE SCHOOL NUTRITIONPROGRAMCriteria and Procedure No: NSE-05-01 Disclosure of Nutritional InformationCriteria and Procedure No: MS-03-01 Fluid Milk SubstitutionsGeorgia Department of EducationRichard Woods, State School SuperintendentPage 5 of 6 January 2015“USDA is an equal opportunity provider and employer.”
Accommodating Children with Special Dietary Needs in the School Nutrition ProgramsAccommodating Students with Disabling Special Dietary NeedsSchools participating in a federal Child Nutrition Program (School Lunch, School Breakfast or After SchoolSnack Program) are required to make accommodations for children who are unable to eat the school mealsbecause of a disability* that restricts their diet. In order to make modifications or substitutions to the schoolmeal, schools must have a written Medical Statement on file that is signed by a licensed physician. Thestatement must identify: The child’s disability An explanation of why the disability restricts the child’s diet The major life activity affected by the disability The food(s) to be omitted from the child’s diet The food or choice of foods that must be provided as the substitute*Only a physician can declare if a student has a disability.Accommodating Students with Non-Disabling Special Dietary NeedsThe school food authority may, at their discretion, make substitutions for students who have a special dietaryneed, but do not meet the definition of disability. Examples include food intolerances or allergies that do notcause life-threatening reactions. The decision to accommodate a student’s special dietary need can bedetermined on a case-by-case basis, however, the school should remain consistent with accommodating specialdietary needs. In order to make modifications or substitutions to the school meal, schools must have a writtenMedical Statement signed by a recognized medical authority identifying the following: An identification of the medical or other special dietary condition which restricts the child’s diet The food or foods to be omitted from the child’s diet The food or choice of foods to be substitutedIn Georgia, a recognized medical authority includes a physician, physician assistant, and nurse practitioner.Milk Substitutions for Students with Non-Disabling Special Dietary NeedsFor students with non‐disabling special dietary needs which restrict their intake of fluid milk, the followingapplies. Parents/guardians or a recognized medical authority (physician, physician assistant, or nursepractitioner) may request a fluid milk substitute for a student with a non‐disabling medical dietaryneed, such as milk intolerance, or due to cultural, religious or ethnic beliefs. The request must bemade in writing.The written request from a parent/guardian or medical authority must identify the student’s medicalor special dietary need that prevents them from consuming cow’s milk. Specifically referring to milksubstitutions, a “special dietary need” can refer to cultural, ethnic, or religious needs, as well asmedical needs.Nondairy beverages offered as a fluid milk substitute must meet the established nutrient standards, asindicated in Question 20 in USDA memo SP 07‐2010, available on the GaDOE SNP website, underSpecial Dietary Needs in SNP Section.Juice and water cannot be substituted for fluid milk as part of the reimbursable meal even whenrequested by a physician. Some schools may routinely offer fruit or vegetables juices on their menusas options for a fruit or vegetable choice. Fruit and/or vegetable juices cannot be offered in place ofmilk, but only as a fruit or vegetable choice for all students. All juice must be 100% full strength.Responsibility of Parents Notify the school of any food allergy, disability or special dietary need.Provide Medical Statement completed by a physician (disability), a recognized medical authority (non‐disabling special dietary need), or the parent (non‐disabling special dietary needs for milk only).Special Dietary NeedsMay 2013
Participate in any meetings or discussions regarding the student’s meal plan. Maintain a healthy line ofcommunication with the school.Notify the school of any changes relating to the special dietary need (a new Medical Statement is required ifthe diet changes).School Nutrition Program Responsibility Provide food substitutions for students according to Medical Statement. The school food service staff may notrevise or change a diet prescription or medical order.Provide training to cafeteria personnel on how to properly accommodate students with special dietary needs.Maintain documentation of this training.Communicate with parents, staff, and medical authorities regarding diet modifications.Maintain Medical Statement on each student with a special dietary need. Diet orders are not required to berenewed on a yearly basis, however, the Georgia Department of Education recommends that you confirm, on ayearly basis, the diet order has not changed. If there are any changes to the diet, a new Medical Statement isrequired.If the school is opting to make a milk substitute available for non-disabling dietary needs, research products toensure they meet the USDA nutrient standards for a milk substitute. Notify the Georgia Department ofEducation, School Nutrition Division if you are making milk substitutes available for non-disabling specialneeds.School Nurse Responsibility Collaborate with School Nutrition Program Director, school staff, parents, and physician to appropriatelyshare pertinent information, obtain a copy of Medical Statement, and accommodate students with specialdietary needs.Develop medical plan of care as appropriate (Individualized Healthcare Plan).Other Federal regulationsBased upon Federal laws that prohibit discrimination and ensure equal access to education, some students mayhave instructions for accommodating their special need written into a 504 Plan or an Individualized EducationPlan (IEP). Typically, a team consisting of the school professionals and the parents collaborate to develop theseplans. If the 504 Plan or IEP involves special dietary needs, the school nutrition program director should beinvolved.Additional Resources:USDA's Accommodating Children with Special Dietary Needs in the School Nutrition ial dietary needs.pdf.USDA Memo SP 36-2013: Guidance Related to the ADA Amendments emos/2013/SP36-2013os.pdfUSDA Memo SP07-2010: Q & As: Milk Substitution for Children with Medical or Special Dietary y-Memos/2010/SP 07 CACFP 04 SFSP 05-2010 os.pdfNational Food Service Management Institute’s Meeting Children’s Special Food and Nutrition Needs in ChildNutrition urceOverview.aspx?ID 89Food Allergy and Anaphylaxis Network: http://www.foodallergy.org/Special Dietary NeedsMay 2013
Food Allergy and Anaphylaxis Network handouts on how to read food labels:http://www.foodallergy.org/files/HTRLsheet 2012.pdfSchool Nutrition Association’s allergy information resources x?id 634Additional Contact Information: Contact the Georgia Department of Education, School Nutrition Division, with questions regardingaccommodating students with special dietary needs in the School Meals Programs at 404‐656‐2738.Special Dietary NeedsMay 2013
Medical Plan of Care for School Nutrition Program(Students with Disabilities and Non-Disabling Special Dietary Needs)The following child is a participant in one of the United States Department of Agriculture (USDA) school nutrition programs. USDA regulations 7CFR Part 15B require substitutions or modifications in school nutrition program meals for childrenwhose disability restricts their diet and is supported by a statement signed by a licensed physician. Food allergies whichmay result in a severe, life-threatening (anaphylactic) reaction may meet the definition of “disability.” The school food authority may choose to accommodate a student with a non-disabling special dietary need that issupported by a statement signed by a recognized medical authority (physician, physician assistant or nurse practitioner). The school food authority may choose to make a milk substitution available for students with a non-disabling specialdietary need, such as milk intolerance or for cultural or religious beliefs. If the school food authority makes thesesubstitutions available, the milk substitute must meet nutrient standards identified in regulations. If available, this will beindicated in Part 2. A parent/guardian or recognized medical authority (physician, physician assistant, or nursepractitioner) may complete this section. If this is the only substitution being requested, complete Part 1 and 2 only.Part 1: To be completed by Parent/Guardian (all requests for special dietary needs)Child’s NameDate of BirthName of School/Center/ProgramGrade Level/ClassroomParent’s/Guardian’s NameAddress, City, State, Zip Code()Home Phone(MF)Work PhonePart 2: Request for milk substitution for non-disabling special dietary
Special Dietary Needs May 2013 Accommodating Children with Special Dietary Needs in the School Nutrition Programs Accommodating Students with Disabling Special Dietary Needs Schools participating in a federal Child Nutrition Program (School Lunch, School Breakfast or After School
It covers sample copy of mandatory procedures covering all the details of ISO 15378:2017. List of procedure 1. Procedure for Management review 2. Procedure for Document and Data Control 3. Procedure for Control of records 4. Procedure for Internal Audit 5. Procedure for Training 6. Procedure For Corrective And Preventive Action 7.
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Understanding and Utilizing the ASAM Placement Criteria David Mee-Lee, M.D. The Change Companies 6 www.changecompanies.net D How and When to Use the Criteria 1. Continued Service and Discharge Criteria (PPC-2R, pp. 7, 35-40; pp 199-204) After the admission criteria for a given level of care have been
ASAM Criteria must require more staff, expense, and administration to provide all the levels ASAM Criteria is a medical model and requires everyone to hire a medical director ASAM Criteria is biased to advocate for more inpatient treatment ASAM Criteria is biased to advocate for more outpatient treatmentFile Size: 556KB
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