Examples of Recognized Medical Authority in a sentence
If this meal modification is due to a medical condition not constituting a disability, the institution/sponsor is encouraged to make the substitution and the form must be signed and dated by a Recognized Medical Authority.
Please have your Physician or Recognized Medical Authority complete and sign this form.
The District may enroll an F-1 foreign exchange student who does not qualify for membership if the student: [a] is a foreign exchange student sponsored by an agency approved by the Director; [b] pay tuition as established iun Policy 6F-101 (School Fees, Fee Waivers and Provision in Lieu of Fee Waivers); [c] complete an application to obtain an I-20 form as required by The Immigration and Naturalization Service in order to receive the F-1 student visa; and [d] is enrolled in the school for one year or less.
CHECK ALL THAT APPLY)caring for one’s selfreadingstandingneurologicalperforming manual tasksseeingconcentratingbendingdigestivecirculatoryeatingthinkingbreathingbowelendocrinewalkinglearningcommunicatingbladderreproductive functionsliftinghearingworkingrespiratoryfunctions of the immune systemspeakingsleepingnormal cell growthbrain Signature of Recognized Medical Authority: Date: *This form will be considered a parent preference if not signed by a recognized medical authority.
Indicate any other comments about the child’s eating or feeding patterns:Name of Recognized Medical Authority: Signature of Recognized Medical Authority: Office Phone Number () Date: Office Stamp: In accordance with federal law and U.S> Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability.
Name of Student: Age: Name of Parent/Guardian: Telephone Number: School District: School Attended by Student: Part II (to be filled out by a recognized Medical Authority)Diagnosis (include description of the patient’s medical or other special dietary needs that restrict the child’s diet): List food(s) to be omitted from diet: List food(s) that may be substituted (diet plan): Additional information: Date Signature of Recognized Medical Authority Telephone Number: This page intentionally left blank.
A Licensed Physician or Recognized Medical Authority checks ONLY ONE box below.
Pressurized water source minimumrequirementsflow rate of 2.5 gpm (9.4liters) at 10psi(70 K pa)shutoff pressure of 5 psi (34.5 kPa).NOTES: for Wiring1.Distances are from source to unit and back to source.
All medication, both prescription and non-prescription, requires a signature, medical license number, and complete, legible instructions from a Recognized Medical Authority*.
All medication, both prescription and non-prescription, requires signature, medical license number and complete, legible instructions from a Recognized Medical Authority*, Homeopathic, herbals, vitamins, and supplements all require a completed and signed Medical Authorization Dietary needs form.*Physician, Physician Assistant, or Nurse Practitioner licensed to practice in the State of California Please indicate if student can self-carry EpiPen or inhaler.