Get Florida Wic Form

The Florida WIC Program Medical Referral Form is an essential document for people seeking nutritional assistance through the Women, Infants, and Children program. This guide provides clear and comprehensive steps for filling out the form online, ensuring users can complete it accurately and efficiently.

Follow the steps to complete the Florida WIC form online:

1. Click ‘Get Form’ button to access the Florida WIC form and open it in your preferred editor.
2. Begin by indicating the client's eligibility for Healthy Start by checking ‘Yes’ or ‘No’. If the client has not been screened, leave this question blank.
3. Fill in the client's name and birth date accurately.
4. Optionally, provide additional information such as the client’s sex, mailing address, phone number, city, zip code, social security number, and the parent’s or guardian’s name for infants and children.
5. Complete the appropriate section based on the client’s category: pregnant women, breastfeeding women, postpartum women, infants, or children. Input the required measurements including height, weight, hemoglobin or hematocrit values, and corresponding dates.
6. Check all applicable health issues that may assist WIC nutritionists in offering better care. Even if no health issues are present, it is recommended to refer the client to the WIC program.
7. If nutrition counseling is desired, mark the appropriate box and specify the dietary prescription or order.
8. Complete the shaded area at the bottom with the health professional’s signature, title, and office details, including the office stamp.
9. Review the completed form for accuracy. Save your changes, then download or print the document to provide to the client or mail it to the local WIC agency.

Complete your Florida WIC form online to ensure you receive the nutritional support you need.