Adopted: November 2018
Revised: July 2024

Download 710.2.4P - Somali Special Diet Statement

Tilmaamaha: Bayaankan cuntada gaarka oo dhammeystiran u gudbi Kalkaaliyaha/kalkaalisada Dugsiga. Foomkani waxa uu ka kooban yahay saddex qeybood. Qeybta koowaad waa in uu buuxiyaa waalidka, qofka mas’uulka ka ah ardayga ama ardayga qaangaarka ah. Qeybta labaad waa in uu buuxiyaa dhakhtar ruqsad haysta, kaaliye dhakhtar oo ruqsad haysta, ama kalkaaliye diiwaangashan oo aqoon duruqsan leh, sida kalkaaliye aqoon duruqsan leh oo shahaadeysan. Qeybta 3aad waxay bixisaa ogeysiisyo sharci si dib u eegis loogu sameeyo. In cusbooneysiin lagu sameeyo foomkan waxaa loo baahan yahay oo kaliya marki baahiyaha ardayga ay isbeddelaan.

Qeybta 1: Macluumaadka Ardayga – Waxaa Buuxinaya Waalidka/Qofka Mas’uulka ka ah

Magaca Ardayga:                                                                                              Taariikhda Dhalashada Ardayga:                                                                                                                

                         Magaca Dambe/Magaca Koowaad/Xarafka u Horreeya Magaca Dhexe                                                                    Bisha/Maalinta/Sanadka

Magaca Dugsiga/Barnaamijka:                                                                                             Taariikhda Maanta:                                                                                                                                                        

Magaca Waalidka/Mas'uulka                                                                                                     Lambarka Taleefanka:                                                                                                                                                                                                                                       

Ardaygaagu ma qorsheynayaa in uu cuno cuntada iskuulka? ☐ Haa ☐ Maya

Haddii ay tahay haa:

☐ Labadaba Quraac & Qado   ☐ Kaliya Qado   ☐ Kaliya Quraac

☐ Dooro maalmaha/cuntada lala socodsiiyo Maareeyaha Goobta Adeegyada Nafaqada

Oggolaanshaha ikhtiyaariga ah

Farriin ku socota Waalidka/Mas’uulka/ Ardayga Qaangaarka Ah: Waxaad u oggolaan kartaa Degmada 196 in ay ayaankan Cuntada Gaarka ah la eegto xirfadlaha daryeelka caafimaadka ardayga adiga oo saxiixaya qeybta Oggolaanshaha ikhtiyaariga ah ee soo socota:

Si waafaqsan qodobada Xeerka Qaadida iyo La Xisaabtanka Caymiska Caafimaadka (HIPAA) ee 1996, Xeerka Xuquuqda Waxbarashada Qoyska iyo Asturnaanta Sirta iyo sharciga gobolka ee u dhigma waxaan halkan u oggolaanayaa dhakhtarka/xirfadlaha daryeelka caafimaadka ee hoos ku xusan inuu sii daayo macluumaadka caafimaadka ee la ilaaliyo sidi loogu baahdo ujeedada gaarka ah ee bixinta macluumaadka cuntada ee Degmada 196 waxaana u oggolaanayaa dhakhtarka/xirfadlaha daryeelka caafimaadka in uu si xor ah macluumaadka ku qoran foomkan iyo diiwaanadooda ula wadaago Degmada 196 sidi loogu baahdo. Waxaan fahamsanahay in aan diidi karo in aan saxiixo oggolaanshahan iyada oo aan saameyn ku yeelanaynin uqalmitaanka codsigeyga ee cuntada gaarka ah. Waxaan fahamsanahay in oggolaanshaha lagu siideynayo macluumaadkan laga laaban karo waqti kasta, marka laga reebo in ka noqoshadeyda aanay saameyn doonin macluumaadki horay loo siidaayay. Macluumaadkan waa in loo siidaayo ujeedada gaarka ah ee codsigayga Cuntada Gaarka ah. Qofka hoos ku saxiixan waxa uu cadeynayaa in iyada/isaga uu yahay waalidka, mas’uulka, arday qaangaar ah ama wakiilka loo igmay ee ardayga ku qoran dukumiintigan oo awood sharci u leh inuu saxiixo isaga oo ka wakiil ah magaca ardaygaas.

Waalidka/Mas’uulka/Ardayga Qaangaarka ah:                                                                                Taariikh:                                                                                                                                                                              

Qeybta 2: Hoysiinta Cuntada – Waxaa Buuxinaya Xirfadlaha Daryeelka Caafimaadka (Dhakhtar ruqsad haysta, kaaliye dhakhtar oo ruqsad haysta, ama kalkaaliye diiwaangashan oo aqoon duruqsan leh)

1.       Aqoonso waxyaabaha xasaasiyada(ha) ku kiciya ee laga fogaanayo:

☐ Caanaha ☐ Ukumaha ☐ Kalluunka ☐ Kalluunka Aargoosatada ☐ Peanuts (Lawska) ☐ Tree Nuts (Geed-Lawska)

 ☐ Qamadiga ☐ Soyga ☐ Sisinta

☐Wax kale:                                                                                                                                                                   

 

2.       Sharraxaad kooban oo ku saabsan sida u dhawaanshaha cuntadan ay u saameyso ardayga:

                                                                                                                                                                                                                         

                                                                                                                                                                                                                              

3.       Qor cuntooyinka gaarka ah ee la iska dhaafayo loona beddelayo, haddii ay habboon tahay. Ku lifaaq tilmaamo dheeri ah haddii loo baahdo.

Fiiro gaar ah: Degmada dugsiga qasab kuma ahan in ay bixiso beddelka dhabta ah ee la codsaday, balse waxa ay bixin doontaa beddel macquul ah oo si wax ku ool ah u daboola naafonimada ardayga.

 

Cuntooyinka laga Saarayo	Cuntooyinka lagu Beddelayo

 

4.       Waxyaabaha xasaasiyada kiciya ma lagu cuni karaa waxyaabaha duban?

☐ Haa: sheeg waxyaabaha xasaasiyada kiciya                                                               ☐ Maya   ☐ Ma Khuseyso

 

Macluumaad Dheeraad ah (buuxi haddii ay khuseyso)

☐ Wax Ka Beddelka Taabashada: ☐ Shurbad ☐ Cunto La Ridqay ☐ Cadad la Goosan Karo ☐ Waxkale:                                  

☐ Quudinta Tuubada: Magaca Dareeraha:                                                                                                                                             

Tilmaamaha Qaadashada:                                                                                                                                                                

☐ Quudinta Afka: ☐ Maya ☐ Haa haddii ay haa tahay, sheeg cuntada:                                                                                         

Wax Ka Beddelada Kale ee Cuntada ama Tilmaamo Dheeri ah (sharrax):                                                                                          

                                                                                                                                                                                                                          

Saxeexa

Dhakhtar ruqsad haysta, kaaliye dhakhtar oo ruqsad haysta, ama kalkaaliye diiwaangashan oo aqoon duruqsan leh sida kalkaaliye aqoon duruqsan leh oo shahaadeysan waa in uu saxiixaa oo uu soo celiyaa nuqulka dukumiintigan.

Magaca:                                                                                                          Taariikhda:                                                                                    

Aqoonsiyada Xirfadlaha Qoraya:                                                                   Rugta/Isbitaalka:                                                   

Lambarka Taleefanka:                                                                             Lambarka Fakiska:                                                                 

X                                                                                  

   Saxiixa Xirfadlaha Daryeelka Caafimaadka

Qeybta 3: Ogeysiisyada

Ujeedada iyo Isticmaalka

Hay’adaha ama ururada sida Degmada 196 ee taabagaliya oona maamula Barnaamijka Nafaqada Carruurta ee federaalku maalgeliyo waa inay beddelaad macquul ah ku sameeyaan cuntada iyo/ama cunnada fudud iyadoo xaalad-xaalad loogu eegayo kaqeybgalayaasha loo arko in ay qabaan naafo xadidaysa cuntadooda: Barnaamijka Nafaqada Dugsiga –7 CFR 210.10(m), Barnaamijka Cuntada Xannaanada Carruurta iyo Dadka Waaweyn – 7 CFR 226.20 (g), Barnaamijka Adeegga Cuntada Xagaaga – 7 CFR 225.16(f)(4). Marka loo eego Xeerka Wax ka Beddellada ADA, inta badan naafooyinka jireed ama maskaxeed ee si weyn u xadida ama u saameeya hal ama in ka badan oo ka mid ah hawlo nololeedka waaweyn ama shaqooyinka jirka ayaa ka dhigan naafo.

Degmada 196 loogama baahna in ay daboosho codsiyada cuntada gaarka ah ee aan ku salaysnayn naafonimada, oo ay ku jiraan codsiyada la xiriira caqiidooyinka diimaha ama akhlaaqda ama doorbidida shakhsi ahaaneed. Haddii codsiyadaan la daboolo, Degmada 196 waa inay xaqiijisaa in dhammaan nidaamka cuntada USDA iyo shuruudaha nafaqada la buuxiyey.

Foomkani waa in uu buuxiyaa dhakhtar ruqsad haysta, kaaliye dhakhtar oo ruqsad haysta, ama kalkaaliye diiwaangashan oo aqoon duruqsan leh, sida kalkaaliye aqoon duruqsan leh oo shahaadeysan. In cusbooneysiin lagu sameeyo foomkan waxaa loo baahan yahay oo kaliya marki baahiyaha ardayga ay isbeddelaan.

Macluumaadka lagu bixiyo foomkan waxaa loo adeegsan doonaa in lagu go’aamiyo in ardaygu uqalmo beddelka macquulka ah ee cuntooyinka oo ku salaysan naafonimada. Marka laga reebo sida uu sharcigu si kale u oggol yahay ama uu dalbanayo u yeerid ama amar maxkamadeed, macluumaadka lagu bixiyo foomkan waxaa kaliya lala wadaagi doonaa shaqaalaha Degmada 196 ee si sharci ah ugy baahan inay ogaadaan macluumaadkaas (sida kalkaaliyaha caafimaadka ee dugsiga iyo shaqaalaha Cuntada iyo Nafaqada ee ku lug leh qiimaynta iyo meeleynta codsiyada beddelka cuntada). Waajib kuguma ahan in aad macluumaad ku bixiso foomkan, balse haddii aadan bixin, waxaa laga yaabaa in degmada dugsigu awoodi waydo in ay ardaygaaga siiso beddel cunto oo macquul ah.

Takoor La’aan

Iyadoo la raacayo sharciga federaalka ee xuquuqda madaniga iyo Shuruucda madaniga ah iyo siyaasadaha Waaxda Beeraha Mareykanka (USDA), Degmada 196 waxaa laga mamnuucay takoorka ku salaysan isirka, midabka, waddanka qofku asal ahaan kasoo jeedo, jinsiga (ay kamid yihiin aqoonsiga jinsiga iyo rabitaanka jinsiga), naafonimada, da’da, ka cadgoosi ama ka aargoosi lagula kaco howl xaquuq madani ah oo hore.

Macluumaadka barnaamijka waxaa lagu heli karaa luuqado aan ahayn Ingiriisi. Dadyowga naafada ah ee u baahan macluumaadka oo qaab kale ah si ay u helaan macluumaadka barnaamijka (sida, Qaabka waxbarashada dadka aragga la’, farta waaweyn ee dadka aragga ka liita, maqaalada la dhegaysto, Luuqadda Dhegooleyaasha Maraykanka), waa in ay la xiriiraan gobolka ka mas’uulka ah ama wakaaladdooda maxaliga ah ee maamusha barnaamijka ama USDA’s TARGET Center halkaan (202) 720-2600 (codka iyo TTY) ama waa in ay USDA kala xiriiraan Adeegga Gudbinta Fariimaha ee Federaalka(Federal Relay Service) halkaan (800) 877-8339.

Si cabasho takoor looga gudbiyo barnaamijka, Qofka cabashada gudbinaya waa in uu buuxiyaa Foomka AD-3027, Foomka Cabashada Takoorka Barnaamijka USDA kaasoo onlaynka laga heli karo halkan: https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint laga heli karo xafiis kasta oo USDA leedahay, iyada oo la wacayo (866) 632-9992, ama iyada oo warqad loo qorayo USDA. Warqadda waa in ay la socdaan magaca dacwoodaha, ciwaankiisa, lamarkiisa teleefoonka, iyo ficilka cunsurinimada ah oo qoraal ah si ku filanna u faahfaahsan si loogu wargaliyo Kaaliyaha Xoghayaha Xaquuqda Madaniga ah (ASCR) nooca iyo taariikhda xadgudubka ka dhanka ah xaquuqda madaniga ah. Foomka ama waraaqda AD-3027 ee la buuxiyay waa in USDA loogu diraa:

(1)     boostada: Waaxda Beeraha Maraykanka

        Xaafiiska Kaaliyaha Xoghayaha Xaquuqda Bulshada

1400  Independence Avenue, SW

        Washington 20250-9410

(2)  Fakiska: (833) 256-1665 ama (202) 690-7442; ama

(3)  Iimayl: program.intake@usda.gov

Degmada 196 waa bixiye fursad loo wada siman yahay.