I am an Educational Advocate and my recommendation is that you go the medical route for a few reasons. Firstly, it will be immediate and can be incorporated into the IEP later since modifications need to go through a more formal process. Secondly, it should be under the supervision of the nursing office, and the school will be more likely to respond positively and enforce it more consistently. Thirdly, if you wanted to change or add to it at any point, it will be a lot easier doing it with a doctor’s note rather than as part of an IEP. In terms of what to put in the letter, I would recommend listing every possible nutritional item that will come from home whether it is currently approved or not by the school (if there are a lot, you could categorize them rather than itemize them). Also, make sure that your son’s doctor writes enough to demonstrate the medical need but no more than necessary because the details of his condition are confidential and none of the school’s business; in other words, the letter does not need to make a case that he should have these items but state that they are recommended by his doctor for medical reasons. It should also state how/when he should consume these, for example, with his medications or at his discretion, or both in order to give him the flexibility to be in control of what he eats/drinks. You may want to print up a list of all the food and drink items to bring to the doctor’s appointment to make it easier for the medical staff to draft a complete and accurate letter. If your son’s school starts before the appointment, see if you can get the letter written prior to the appointment. One thing to keep in mind is that the school’s request for a medical note for students to ingest anything protects them and you. Although they sound like they may be going a bit overboard, try not to feel that they are being unnecessarily difficult or doing their job poorly. They probably should have requested it from the beginning rather than made an informal agreement or an exception. I hope this helps. Good luck!