school food authority / school nutrition services / Food allergies / /
MedicalCondition
Food allergies / lactose intolerance / /
Organization
United States Department of Agriculture / Medical Authority / Physician/Medical Authority / /
Position
Director Signature Date Health Insurance Portability and Accountability Act Waiver In accordance with / Nutrition Program Director / physician / licensed physician / official representative / School Nutrition Manager and the Nurse / physician / physician assistant / nurse / /