Parent /Guardian notifies Food & Nutrition Services (FNS) about a dietary disability Parent Special Diet Information Packet is provided to parent /guardian. or available at any CSSD11 School Kitchen FNS Parent/Guardian complete and submit: “Medical Statement for Dietary Disability- School Meal Modification” form completed for dietary disability( special meal accommodations made only for dietary disabilities) with Licensed Physician signature & printed name. An identification of the medical or other special dietary condition which restricts the child’s diet; The major life activity affected by the disability; and The food or foods to be omitted from the participant’s diet, and the foods that must be substituted. CSSD11 Administrative Dietitian may contact Doctor’s office with any questions or to confirm information provided. Parent/Guardian returns applicable form to School’s Kitchen Manager once complete. If any changes to diet order are made, a new “ Medical Statement for Dietary Disability- School Meal Modification” form must be completed, signed by a licensed physician and submitted to D11 FNS. Before a diet order can be stopped, “ Discontinuation of School Meal Modifications Prescribed by a Licensed Physician” form must be completed, signed by a licensed physician and submitted to D11 FNS. Parent Kitchen Manager makes copies for School Office and kitchen, sending original forms to the Food & Nutrition Services office. Administrative Dietitian reviews “Medical Statement for Dietary Disability- School Meal Modification” for completeness. Administrative Dietitian determines if student’s condition is a disability and/or life threatening special dietary need, notifying parent. Administrative Dietitian completes the CSSD11 Kitchen Information Card for the student and sends to the school with a small colored dot for the student’s ID or meal card. Copies provided to school’s nurse and office. Administrative Dietitian creates customized electronic student profile and sends instructions for accessing ingredient information and ordering meals to parent/guardian. FNS Managing a Student’s Special Dietary Needs System Overview July 20, 2015

Managing a Student’s Special Dietary Needs FNS Response for Requests with Special Dietary Needs Fluid Milk/ Lactose Intolerance (Non- life threatening) CSSD11 FNS Response Water and/or juice are available to all students daily at breakfast and lunch, with the exception of Breakfast in the Classroom schools where juice is available twice weekly. No special food or beverage accommodations are made for lactose intolerance that does not rise to the level of dietary disability. Fluid Milk Intolerance Solid Food Sensitivity (Non-life threatening) CSSD11 FNS Response No special meal will be prepared for student by CSSD11 Food & Nutrition Services personnel. o Parent/guardian has the option to set up customized student profile to review menu ingredients at o Once parent/guardian has completed online registration at they will have the option of selecting specific foods that their student has been found to have a sensitivity to (non-disability). Parent/guardian will then have the ability to view published school menus and ingredients of each menu item. o Parent/guardian should work with student to decide which foods on the menu are appropriate meal choices for their student when they choose to eat in the school cafeteria. Solid Food Sensitivity Dietary Disability CSSD11 FNS Response o Kitchen Information Card is completed for the student; copies provided to School Kitchen staff, School Office staff and School Nurse. o Parent/guardian notified that their student’s special dietary need has been processed as a dietary disability by Administrative Dietitian. Determination based on information provided in “ Medical Statement for Dietary Disability-School Meal Modification” that has been completed and signed by a licensed physician. PLEASE NOTE: No accommodations can be made for dietary disabilities unless signed by a licensed physician (M.D. or D.O.). o “Allercode” is created by Administrative Dietitian and parent/guardian is given instructions to access custom student profile on Information/instruction sent to parent/guardian via US Mail. o Student’s ID or Meal ID card is marked with a small colored dot to alert kitchen staff about the special diet needs. Manager’s Alert is set in POS system. o Parent/guardian reviews available menu choices for student on choosing from regular menu items or special entrée available. Parent/guardian completes electronic FNS Special Diet Daily Order Form and submits to Kitchen Manager via not later than noon two days prior to the Special Meal service. Parents/Guardians may submit up to a week’s worth of FNS Special Diet Daily Order Forms at one time. PLEASE NOTE: Items that are part of the regular printed menu have not been prepared in a manner to prevent cross contamination of other allergens. Parent/guardian selects these items at their own discretion. If we do not receive a FNS Special Diet Daily Order Form for your student and he/she requests a meal, a designated meal that has been determined to be appropriate for your student’s special diet may be served to your child. NOTE: It is the responsibility of the parent/guardian to contact the school’s Kitchen Manager by 7:30 a.m. the day of meal service if a meal was ordered and the student will not be eating on the day of the specified meal service. If a meal is prepared and the student does not pick up the meal, the student’s account will be charged full meal price for that meal if it is wasted. Dietary Disability July 20, 2015

Parent All responses to requests will be made in accordance with guidance provided by USDA on this matter. Administrative Dietitian maintains student special diet profile in District 11 database of reported special diets. Administrative Dietitian creates customized student profile according to licensed physician’s direction as documented in the “ Medical Statement for Dietary Disability-School Meal Modification” form. Kitchen Manager Responsibilities Special Diets may only be accommodated by FNS Staff when current forms are approved and on file with the Administrative Dietitian. CSSD11 Kitchen Information card is maintained in the Kitchen’s Student Special Diet Binder at the POS station on the serving line. Maintain current information in an organized manner within the binder provided. Meet with student, parent/guardian, dietitian, and nurse when requested to review information. Set POS warning in system and mark the ID Card or Meal Card with a small color coded dot to identify special diet exists. If Student ID (MS/HS), call student into kitchen to mark ID card. Provide information as needed to help the student, parent, and the FNS Department. Work with the Administrative Dietitian to manage the special diet in District 11 School Meal Programs. Make food substitutions as required by CSSD11 FNS, watching for foods that may contain identified food allergens. Students with life threatening special diets and/or disabilities that involve special meal service requires FNS Staff to prepare a special wrapped plate. Cross contamination must be prevented for these students. The wrapped plate is a full meal, including beverage. FNS Managing a Student’s Special Dietary Needs Roles and Responsibilities July 20, 2015 Note: Staff should never make dietary/menu changes without approved FNS forms as per USDA regulations. Educate the child in self-management of their food allergy including: Safe and unsafe foods Review the CSSD11 Web Site and/or Allerschool.com website with child to learn which foods contain various allergens Strategies for avoiding exposure to unsafe foods Symptoms of allergic reactions How and when to tell an adult that they may be having an allergy-related problem How to read food labels (age appropriate) Maintain updated records at all times with Food & Nutrition Services Provide an updated “ Medical Statement for Dietary Disability-School Meal Modification” form. Note: nothing can be evaluated and implemented until a current “ Medical Statement for Dietary Disability-School Meal Modification” form is received, reviewed, approved, and distributed by the CSSD11 Administrative Dietitian. Parent/guardian will be notified.