If you want to track the incremental cost of gluten free food as a medical expense on Schedule A, the IRS expects written documentation from your doctor that your gluten free diet is medical treatment for a diagnosed condition, not a lifestyle choice.
That requirement comes from Revenue Ruling 55-261, which the IRS still applies today and cited directly in Private Letter Ruling 202311001. This template gives your physician the exact language to provide it.
A one-page statement for your tax records. It is not the same as a Letter of Medical Necessity for an HSA or FSA administrator; the doctor's letter is addressed to your tax file, frames the gluten free diet as treatment for a diagnosed disease, and is the document you keep on hand for your CPA or tax professional to review.
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Editable templates, ready to use
Every version is an editable starting draft, never a locked template. Edit it to fit your situation before you send it.
Bracketed fields are for you or your doctor to fill in. Everything else is the language that makes the letter work.
Provider letterhead
[Provider Name / Practice Letterhead]
[Provider Address]
[Provider Phone] | [Provider Email or Fax]
Date: [MM/DD/YYYY]
To Whom It May Concern (Internal Revenue Service / Tax Records):
RE: Medical Necessity of Gluten Free Diet for [Patient Name]
Patient Name: [Patient Full Legal Name]
Date of Birth: [MM/DD/YYYY]
Diagnosis and medical necessity
I am the treating physician for the above-named patient. The patient has been diagnosed with celiac disease (ICD-10 code K90.0), confirmed on [DATE OF DIAGNOSIS] by [METHOD: e.g., positive serology and small bowel biopsy demonstrating villous atrophy].
A strict, lifelong gluten free diet is the only medically accepted treatment for celiac disease. It is medically prescribed for this patient solely for the alleviation and treatment of this illness, and it is required to prevent serious complications including malabsorption, anemia, osteoporosis, neurological symptoms, and an increased risk of small bowel lymphoma.
The gluten free diet, and the gluten free foods consumed under it, are not part of the patient's normal nutritional needs. They are medical treatment for a diagnosed disease. This statement is provided to support the patient's claim of these expenses as medical expenses under the framework set forth in IRS Revenue Ruling 55-261 and IRS Publication 502.
The patient's gluten free dietary requirement is lifelong. There is no cure for celiac disease, and any reintroduction of gluten causes ongoing autoimmune damage to the small intestine.
I certify that the above information is true and accurate to the best of my knowledge.
Provider certification
Provider Name (printed): [Dr. Full Name]
Credentials: [MD / DO / NP / PA, plus board certification if applicable]
NPI Number: [10-digit NPI]
State License Number: [License Number, State]
Provider Signature: ______________________________
Date Signed: [MM/DD/YYYY]
The documentation requirement and framing come from primary IRS guidance.
- IRS Publication 502, Medical and Dental Expenses irs.gov/pub/irs-pdf/p502.pdf
- IRS Private Letter Ruling 202311001 (cites Rev. Rul. 55-261) irs.gov/pub/irs-wd/202311001.pdf
- Celiac Disease Foundation celiac.org
Friendly reminder. This template is general educational information, not tax or legal advice. Keep the signed letter with your records and have your CPA or tax professional review your Schedule A before filing.