Get Wic Formulas And Foods Prescriptions Form - Washington State ... - Doh Wa 2020-2025
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How to fill out the WIC Formulas And Foods Prescriptions Form - Washington State online
Filling out the WIC Formulas And Foods Prescriptions Form is crucial for ensuring that children receive the nutritional assistance they need. This guide provides step-by-step instructions for accurately completing the form online to streamline the process and facilitate access to essential resources.
Follow the steps to successfully complete the form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the child's name and date of birth in the appropriate fields at the top of the form. Also, include the caregiver's name for identification.
- In the medical diagnosis section, check all applicable diagnoses that the child has from the provided list. If any diagnosis requires additional explanation, provide notes in the space provided.
- Next, in the formula prescription section, select the type of formula needed by checking the respective box. If applicable, specify the daily amount of formula in ounces, ensuring it does not exceed WIC limits.
- Indicate the length of time for which the formula is prescribed. Select from options such as 3, 6, or 12 months, or write in another term not exceeding 12 months.
- For WIC supplemental foods, state whether a WIC dietitian will determine the food type and amount, or check any foods your child cannot tolerate. Note any alternatives required in Box 4.
- Complete the healthcare provider's information section, ensuring that the provider’s name, signature, and contact details are properly filled out and legible.
- Fill out the release of information section, ensuring the caregiver authorizes WIC staff to communicate with the healthcare provider. The caregiver must sign and date this section.
- Review the form for completeness and accuracy. Save any changes made, then download or print the form as needed for submission.
Complete your WIC documents online today to ensure timely assistance.
WIC provides several well-known brands of formula to ensure families have access to trusted products. These brands are carefully selected to meet nutritional guidelines and include options that cater to varying dietary needs. For a complete list of all brands available in the program, it’s best to consult the WIC Formulas And Foods Prescriptions Form - Washington State ... - Doh Wa.
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