School Nutrition

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Instructionsfor Special Dietary Needs Prescription Form


HCSD School Nutrition Program will make modifications andsubstitutions to the regular school meals for a student with a disability that restricts their diet. The HCSD SpecialDietary Needs Prescription Form must be completedand signed by a physician for a student with a disability before the schoolcafeteria can provide any modifications or substitutions. The completed formmust be provided to the School Nutrition Program, including the school cafeteriamanager.  The school cafeteria staff willprepare the meal along with the other meals being served that day.


Follow these steps to ensure a student with a disabilityrequiring special nutrition needs is served the proper diet in the schoolbreakfast, lunch and snack programs:


  1. Have the Special Dietary Prescription Form completely filled out. The prescription must be completed and signed by a licensed physician if the student has a disability.
  2. Regulations require that this documentation be on file for each student who receives a special meal. This documentation must be on file in the school cafeteria and nurses office.
  3. Work with the cafeteria manager to know what foods will be served at school.
  4. The dietitian, school nurse, or other health professional may suggest that the special dietary needs be included in the Individual Education Plan (IEP) or the 504 Plan, as appropriate.


Harris County School Nutrition Program will try toaccommodate special dietary needs or religious preferences for students withouta disability. Such determinations are made on a case-by-case basis by theSchool Nutrition Program, and must be supported by the same Special DietaryPrescription Form signed by an authorized licensed medical authority.


For further information, including definitions ofdisability and of other special dietary needs, and school's responsibility,please visit USDA's Student Nutrition website at



Download the Special Dietary Needs Prescription Form