Special Diet Request

Pinellas County Schools Food and Nutrition strives to provide meals for students with special dietary needs. Our policy for handling food allergies and dietary restrictions mirrors federal regulations. If your student requires a menu modification or special diet, you must submit our "Medical Statement to Request the Special Meals Accommodations" form:

MEDICAL STATEMENT TO REQUEST SPECIAL MEALS AND ACCOMMODATIONS FORM

To request modifications to a school meal, our Food and Nutrition department must receive a “Medical Statement to Request Special Meals and Accommodations” form completed and signed by a state licensed medical authority (physician, physician’s assistant, nurse practitioner, or registered dietitian). Please return the form to the School Cafeteria Manager at your student’s school. An updated form is required when a student changes schools/sites, and when a licensed medical authority changes diet orders. Incomplete forms will be returned to the parent/guardian.

Any student who has a life-threatening food allergy or disability (physical or mental) that restricts the student’s diet and/or major life activities, according to USDA regulations*, is eligible for a school meal modification.

Special Dietary needs and requests, including those related to general health concerns, personal preferences, and moral or religious beliefs are not disabilities and may not be accommodated. The school food service team may, at their discretion, make substitutions for students who request accommodation but do not meet the disability criteria.

1. Fill out “Medical Statement to Request Special Meals and/or Accommodations” Form.
2. Parent/Guardian must return completed and signed form back to Food and nutrition café manager.
3. Café manager will share a form with the Nutrition Coordinator, who may reach out with questions or adjustments needed.
4. Parents/Guardians should temporarily provide students with meal from home while request is being processed for food accommodation.
5. Approval/denial is communicated to café manager and parent/guardian.
6. If approved, parents will receive a menu to indicate what foods the student can or cannot have.

You may visit MealViewer to view allergen and carbohydrate count information for our menus and menu items to assist you in working with your student on food and beverages that are applicable for their dietary needs. Please review the list regularly because the menu items and their ingredients can change throughout the year. To find nutrition and ingredient information, visit our website.

To CHANGE/MODIFY or DISCONTINUE a special meal request, a new “Medical Statement to Request Special Meals and/or Accommodations” Form must be signed and submitted to Café Manager. Medical authority signature is NOT required to discontinue accommodation.

*USDA Rehabilitation Act of 1973, Section 504; 7 CFR Part 15b; 7 cfr Sections 210.10(i)(1),210.23(b),215.14, 2208(f), 225.16(g)(4), and226.29(h)

NOTICE: Due to occasional food substitutions by our suppliers and possibility of residual or cross contamination of allergens and non-allergens in manufacturing plants as well as the ability of manufacturers to omit small percentages ingredients listing, it is impossible to guarantee an allergen free environment.