Medical Statement for Children with Special Dietary Needs

USDA Regulation 7 CFR Part 15b requires substitutions or modifications in school meals for children whose disabilities restrict their diets. A child with a disability must be provided substitutions in foods when that need is supported by a signed statement from a licensed physician.

Each special dietary request must be supported by a statement explaining the requested food substitution and must be signed  by a recognized medical authority. The Medical Statement must include:

  • An identification of the medical or other special dietary condition which restricts the child’s diet;
  • An explanation of what must be done to accommodate the child's disability; and
  • The food or foods to be omitted from the child’s diet; and
  • The recommended alternatives
  • In other cases, more information may be required. 
  • If the child requires caloric modifications or the substitution of a liquid nutritive formula to accomodate a disability, this information must be included in the statement. 
  • If the child's IEP or 504 plan includes the information required in the medical statement, or if the SFA obtains written medical verification of the impairment during the IEP/504 plan process, it is not necessary for the SFA to obtain a seperate medical statement. 
  • If a meal modification for the child's disability can be made within the program meal pattern, a medical statement is not necessary.
  • 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 there is a health plan with the nurse, the allergen information will be shared with the School Nutrition Manager who will put it into a dietary note.  This note will pop up on the screen each time the student enters a PIN.
  • Students with milk allergies may have soy milk as part of their meal at no extra cost. A physician's note is required.
  • Online monthly menus are interactive.  Users may check common food allergens and ingredient lists for menu items.
  • Serving lines have food identification signs with symbols listed. Please reference to the image on the right.



2019-2020 Procedural Handbook for Students with Allergies


Dear Allergy Committee Members,

I wanted to thank each of you for your hard work and commitment to the Allergy Committee as we collaboratively revised and provided recommendations for the 2019-2020 Procedural Handbook for Students with Allergies.  Your input has been very important in this process.  During the past month, the handbook has been reviewed by Principals, LCPS Central Office Staff and other stakeholders for additional editing.  Building on the committees input and recommendations, and additional input from LCPS staff, the Department of Pupil Services has adopted the attached version.  We have already sent the Allergy Aware Flyers to schools and we will have ongoing training with principals to ensure a consistent message.  In addition, our training practices will include many of the recommendations put forth by the committee, and allergy awareness training will be made available for LCPS staff.  Finally, during our committee meetings, we established how important it is to create a culture that is Allergy Aware.  This procedural handbook, training, and a consistent message will establish the foundation to reach that goal.  

Please know that the Allergy Procedural Handbook is a fluid document and continues to be a work in progress.  Student Health Services will have a full committee review of the handbook annually to ensure our procedures and practices remain current.   


Again, thank you for your participation in this process.


Jeannie Kloman, BSN, RN, NCSN
Loudoun County Public Schools
Supervisor, Student Health Services


Gluten Free Menus

Gluten free menus are available for all grade levels in Loudoun County.  If a student requires a gluten free meal, School Nutrition asks that parents and/or students do the following:

  • Please contact the School Nutrition Manager at your child's school AT LEAST 48 hours in advance to notify them of your child's dietary needs and learn what menu items are available.
  • The items on the gluten free menu may contain other allergens, so please make sure to view the allergen information for all items on our website.
  • All allergen information is taken directly from manufacturer’s labels and databases and is subject to change without notice. LCPS School Nutrition does not guarantee the information and provides it solely for your convenience. School Nutrition does everything we can to accommodate special dietary needs, however, the safest meals are those brought from home. 
  • Fill out the Gluten-Free submission form here.
  • If you have questions or concerns regarding the gluten free menu or any allergen questions, please contact Brittany Palaschak, RDN at [email protected]


Vegetarian and Vegan Diets

We offer a number of menu items that meet the needs of a vegetarian and vegan diet.  All menu items that meet these dietary preferences are highlighted by the symbols shown to the right.


USDA is an equal opportunity provider and employer. 

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