Allow the following therapeutic diet allowance through the cash benefit when prescribed by a doctor:
| Code |
Monthly Amount |
Definition |
| 351 TD |
$ 5.95 |
Ulcer and other chronic conditions requiring a bland low residue diet |
| 351 TD |
7.92 |
Diabetic - less than 1700 calories |
| 351 TD |
17.82 |
Diabetic - 1700 calories or more |
| 351 TD |
12.85 |
High protein
High calorie
High vitamin |
- Send Request for Therapeutic Diet Allowance (Form 146) to the client's doctor.
Completion of the form by the doctor or a letter containing information regarding diagnosis and type of diet meets the requirement for a prescribed diet.
- Approve the diet allowance for the time specified by the doctor.
If no time period is specified, the allowance may continue for 12 months.
- Begin the renewal process at the end of the 11 months or as indicated.
- The doctor must sign the order for renewal.
- Keep necessary controls.
- Request for dietary supplements are to be made by the provider (see WAG 20-18-02).