General Relief Policy - Department of Public Social Services

High Caloric High
Protein moderate
need, 3000 calories
100 gr. Protein
High Caloric High
Protein moderate
need, 3400 calories
125 gr. Protein
$5.27 $5.27
$9.60 $9.60
Bland $4.69 $4.28
Low Caloric
1500 calories
Low Fat, Low
Cholesterol
50 gm. Fat
No
Allowance $1.72
$3.88 $3.67
GR 44-231.3 Controls
for Therapeutic Diet
Are there any controls that need to be used for
therapeutic diet?
Yes, the FAC must be established to follow-up on the
PA 596. (The PA 596 is sent to County medical
facilities for renewals only, not for initial requests.)
GR 44-231.4
Verification
If the individual has a diet authorization other
than a completed PA 596 or H-4015, is that
sufficient verification?
No, when an individual is under the care of a private
hospital or physician and has a diet authorization
other than a completed PA 596 or H-4015, Part I of
the PA 596 is completed and the original mailed to
the physician or hospital.
Verification from County Medical Facility: If the
individual is under the care of a County medical
facility, the PA 596 must originate from that facility. If
an individual states that a doctor at a County medical
facility recommends a special diet and a request form
has not been received, the individual should be
advised to contact the physician at the appropriate
facility for clarification.
NOTE: District Staff does not contact the facility in
these instances.
NOTE: The PA 596 completed by County medical
facilities must be signed or it cannot be
accepted nor processed.