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​Substitutions must be made to the regular meal, including milk for any child with disabilities (i.e. a life-threatening reaction when exposed to the food and/or beverage) when the following two requirements are met:

• A licensed physician's statement is required. Pursuant to Section 27-8.1 of the School Code, the licensed physician that may perform student health examinations is a physician licensed to practice medicine in all of its branches. Child Nutrition Program Sponsors can provide the form below to families for a physician to complete 
• Medical Authority Modified Meal Request Form
  
• Formulario de Solicitud de Comida Modificada por la Autoridad Médica​​
  
• The Statement must include the child's disability, explanation as to how the disability restricts the child's diet, the major life activity affected by a disability, and food(s)/beverage(s) to be omitted and foods/beverages to be substituted

For children with disabilities only requiring modifications in food texture (such as chopped, ground, or pureed), a licensed physician's written instructions indicating the appropriate texture is recommended, but not required.

Guidance/Q&A:

• School Nutrition Programs​
  
• Child and Adult Care Food Program & Summer Food Service Program
  

• A signed statement from a parent/legal guardian or "medical authority" is required. A medical authority would include licensed physicians, chiropractic physician assistants, and nurse practitioners. Child Nutrition Program Sponsors can provide the sample form to families ot medical authority to complete.
  
• Modified Meal Request​ 
  
• Solicitud de comida modificada​
  
• The statement must include the food(s)/beverage(s) to be omitted from the student’s meal based on preference and food(s)/beverage(s) to be substituted. If a non-dairy milk substitute (i.e; soy milk) is served, it must meet the nutritional standards of milk as outlined below.
  

Any fluid milk substitution that meets these requirements may be made by the SFA for non-disabled students when the following requirements are met:

• A signed statement from a medical authority, parent or guardian which includes the medical or other special dietary reason for the need for substitution. Any reasonable request could be accepted (e.g. milk allergy, vegan diet, and religious, cultural or ethical reasons). 
  
• The Child Nutrition Program Sponsor may choose the nondairy beverage to be provided, as long as the substituted beverage includes the following nutrients:

  Nutrient	Per Cup
  Calcium	276 mg
  Protein	8 g
  Vitamin A	500 IU
  Vitamin D	100 IU
  Magnesium	24 mg
  Phosphorus	222 mg
  Potassium	349 mg
  Riboflavin	0.44 mg
  Vitamin B-12	1.1 mcg

  
  Because the Nutrition Facts Label in food products does not list all the required nutrients listed above, the food service operation must request documentation from the product manufacturer to confirm the presence of all required nutrients at the proper level. NOTE: Lactose-free milk provides the same nutrients found in regular cow's milk; therefore, it can be served as part of the reimbursable meal without documentation/written statement.
• Expenses that exceed program reimbursements must be paid by the Child Nutrition Program Sponsor for fluid milk substitutions
• The Child Nutrition Program Sponsor must inform the State agency of school that choose to offer fluid milk substitutions for non-disabled students or child care center/home.
  
• The substitution request must remain in effect until the request is revoked or the school changes its fluid milk substitution policy for non-disabled students.
  

Child Nutrition Program Sponsor​s can receive reimbursement for meals without milk if they operate Offer versus Serve (OVS), under which milk or other meal component(s) could be declined by a student. If a Child Nutrition Program Sponsor​ does not however operate OVS, a non-disabled child with a medical or special dietary need must take the regular fluid milk or an acceptable milk substitute provided by the school or child care/home in order for the meal to be claimed for reimbursement.​

• ​Anaphylaxis Response Policy for Illinois Schools​
  
• ​​CDC’s Food Allergies in Schools Toolkit
• Food Allergy Research & Education (FARE) - Common Allergens
• Food Allergy Research & Education (FARE) – How to Read a Food Label
• ISBE Wellness Department – Allergies & Undesignated Epinephrine
• School Nutrition Association Food Allergy Resource Center
• USDA’s Food Allergy Book​​
  

• Handbook for Managing Special Dietary Needs in School Food Service​
• USDA's Guidance On Meal Accommodations in Schools
  
• Federal Laws, Regulations and Resources
• NSBA Center for Safe Schools​