Soy Milk Notification Form and Medical Substitution Form

1. Soy Milk Notification Form and Medical Substitution Form

2. Soy Milk Notification Form When to use? • When a parent requests that their child receive Soy Milk. Who must complete the form? • The parent or guardian of the enrolled child. Can a center receive reimbursement when serving soy milk? • Yes. • Only the five (5) approved brands of Soy Milk are reimbursable Who is responsible for purchasing the soy milk? • The center may either provide one of the five approved brands of soy milk, or the parent can indicate that they will provide one of the five approved brands of soy milk (found on the Soy Milk Notification Form).

3. CACFP Creditable Soy Milks Pacific Natural Ultra Soy Milk Plain or Vanilla 8th Continent Original Soymilk Kikkoman Pearl Organic Soymilk Smart Creamy Vanilla or Smart Chocolate 8thContinent Original Soy Milk Pacific Natural Ultra Soy Milk Pacific Natural Ultra Soy Milk, Vanilla Kikkoman Pearl Organic Smart, Creamy Vanilla Kikkoman Pearl Organic Soymilk Smart, Chocolate CACFP Creditable Soy Milks

4. State Agency Soy Milk Notification Form

5. Medical Substitution Form When to use? • When a child is not receiving a complete, creditable meal that meets CACFP meal pattern requirements. • Ex. meat or creditable meat alternates, fluid cow’s milk Who must complete the form? • A recognized and licensed medical professional. Can a center receive reimbursement when a medical substitution is served? • Yes. • The center can only receive CACFP reimbursement if the substitution is required by a medical professional. • The food substitution must be clearly identified on the form. • Examples: Rice milk , Almond milk, SILK soymilk, Tofu, etc. Who is responsible for purchasing the “medical substitution” food? • The center should accommodate the substitution if the cost isn’t unreasonable. • If doctor identifies the need as a disability on the form, the center must purchase and servethe substitution, unless the specified food is cost prohibitive.

6. State Agency Medical Substitution Form (Front)

7. State Agency Medical Substitution Form (Back)

8. Questions