Special Meal Accommodations 

Medical Statement for Children with Special Dietary Needs

Each special dietary request must be supported by a statement explaining the requested food substitution and must be signed by a recognized medical authority. A state licensed healthcare professional in Tennessee includes a medical doctor, podiatrist, dentist, optometrist, osteopathic physician, physician assistant, or nurse practitioner. Chiropractors are not included at this time. The Medical Statement must include:

• 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; and should include
• The food or choice of foods to be substituted.

If we do not receive a medical statement from a recognized medical authority, your child will receive a regular lunch tray.  Medical statements completed by parents or guardians will not be accepted.

When special dietary needs are no longer required for the child, the parent or guardian must contact the School Nutrition Supervisor at 615-215-2104. A medical statement from a state licensed healthcare professional is not required to resume a regular diet. Communication from the parent or guardian is sufficient. Forms do not have to be updated yearly unless a change has occurred.

Meal Modification forms can be obtained from the link below, School Nurse offices, or the office of the School Nutrition Supervisor. Completed forms must be turned in to the School Nurse and then forwarded to the Cafeteria Manager and School Nutrition Supervisor.