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cnp 925

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California Department of Education Nutrition Services Division Child Nutrition Programs CNP - 925 Rev. 8/17 Page 1 MEDICAL STATEMENT TO REQUEST SPECIAL MEALS AND/OR ACCOMMODATIONS 2. Site Name 1. School or Agency 3. Site Phone Number 4. Name of Child or Participant 5. Age or Date of Birth 6. Name of Parent or Guardian 7. Phone Number 8. Description of Child or Participant s Physical or Mental Impairment Affected 9. Explanation of Diet Prescription and/or Accommodation to Ensure Proper...
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The requested nutrition program or site shall provide additional, written evidence that there are insufficient foods or nutritional products available for a child and that a child is unable to meet adequate nutritional needs.

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