Only specific medical professionals registered in Ontario can legally fill out and sign the medical sections of your Special Diet Form PDF. These include:
Diabetes (Type 1 or 2 requiring insulin or oral medication) ☐ Hypoglycemia (documented blood sugar below 3.9 mmol/L) ☐ Renal Disease (chronic kidney disease, dialysis) ☐ Malabsorption / Celiac Disease (gluten-free required) ☐ Dysphagia (swallowing disorder – requires pureed or thickened foods) ☐ Hepatic Disease (liver failure/cirrhosis) ☐ Severe Food Allergies (life-threatening – specify allergens: __________) ☐ Metabolic Disorder (e.g., PKU, galactosemia – diagnosed by specialist) ☐ Pregnancy (multiple fetuses or documented nutritional risk) ☐ Lactation (breastfeeding with documented low maternal weight) ☐ Other (specify diagnosis & dietary requirement): _________________ special diet form odsp pdf
The form requires information about the individual's medical condition, dietary needs, and the cost of the special diet. Special Diet Allowance Funding Rates
(Note: ODSP maximum special diet allowance per month is typically $250 unless exceptional circumstances are documented.) special diet form odsp pdf
Registered Midwives (only for pregnancy or insufficient lactation conditions). Special Diet Allowance Funding Rates