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Meal Modifications


  1. Meal modification form 19-B is obtained by parent from the school, food service department or can be downloaded here.
  2. Parent and physician complete form.
  3. Parent returns completed form to building secretary or food service.
  4. Food service personnel follow up on meal modification form 19-B with parent and gives copy to school nurse.
  5. Form 19-C is obtained by parent, completed by the parent and physician and returned to school secretary or food service to discontinue a meal modification.

Meal modification forms should be obtained by the parent, completed by the physician, and returned to food service or the school secretary. If the form is returned to the school secretary, it should be forwarded to food service.

Food service personnel contact the parent to discuss the meal modification and clarify any questions.

A copy of the meal modification form should be provided to the school nurse for the purpose of documenting food allergies. Life threatening food allergies will be noted in the conditions tab of Infinite Campus and will be noted on the teacher roster with an asterisk.


On page 7 of the USDA food and nutrition service guidelines it states that “Under no circumstances are school food service staff to revise or change a diet prescription or medical order.” To stop a meal modification order form 19-C must be completed.

The medical statement to Request School Meal Modification form 19-B applies to food served by school food service. It does not regulate food that is not provided by school food service and brought into the classroom.

Parents should communicate preferences for foods/snacks in the classroom directly to the teacher.




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