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Adult Medical Substitution Form


Updated: August 2020

A Medical Substitution Form must be on file for any participant with a special dietary need that cannot be accommodated within the CACFP meal pattern requirements, such a child with dairy and soy allergies who much have rice milk instead of cow's milk. The parent/guardian should have the Form completed by a recognized medical authority, such as a licensed physician (doctor) or nurse. The Form must indicate the food(s) to avoid and the food(s) that should be substituted.

Related Content: Child and Adult Care Food Program (CACFP)