Medical Statement Form

Students with Special Dietary Needs

Downey Unified School District will, when possible, provide food substitutions or accommodations on a case-by-case basis for children with medically certified special dietary needs.  The student must have a medical statement on file defining their certified special needs.

Students with Disabilities

Downey Unified School district will make food substitutions or accommodations for students with disabilities.  Substitutions for these students must be prescribed by a state licensed healthcare professional.*

Students with Food Allergies

Downey Unified School District will not make food substitutions for student with allergies unless a documented physician’s assessment is on file.

IMPORTANT NOTICE TO PARENTS AND GUARDIANS:  Ingredients and menu items are subject to change or substitution without noticeStudents with severe or life-threatening allergies are recommended to bring meals from home.

Medical Statement Form

Return the completed form to your school site nurse at the beginning of each school year for processing.

*For this purpose, a state licensed healthcare professional in California is a licensed physician, a physician assistant, or a nurse practitioner.

IMPORTANT NOTICE: Food Allergies

The Food Services Department cannot be responsible for ensuring that a child’s menu selections are free from allergens. Students with life-threatening food allergies are encouraged to bring meals from home.

We serve peanut products in all Downey Unified School District Schools. We cannot guarantee that the foods we purchase have not been in contact with nuts during manufacturing.

This institution is an equal opportunity provider.