Get Arizona Wic Milk Alternative Request Form - Azdhs

Filling out the Arizona WIC Milk Alternative Request Form is an essential step for participants seeking milk alternatives due to medical reasons. This guide provides clear instructions on completing the form accurately to ensure timely processing.

Follow the steps to effectively complete the WIC Milk Alternative Request Form.

1. Press the ‘Get Form’ button to access the form and open it in the appropriate editor.
2. Enter the required client name and date of birth in the respective fields. This information helps to identify the user and authenticate their request.
3. Provide the WIC client ID. This ID is crucial for tracking the user's participation and ensuring they receive the correct benefits.
4. In section 1, indicate the current request by selecting the appropriate milk alternative, such as 'Soy Beverage' or 'Goat Milk.' Be aware that medical documentation is required for certain requests, particularly for children.
5. Complete section 2 by detailing the medical reason or need for the request. This may include options like 'Lactose Intolerance' or 'Milk Protein Allergy.'
6. In section 3, specify the length of time for the milk alternative request. This can be noted in months or weeks, or indicated as 'up to a year.'
7. Fill in the provider name, their title, and obtain a healthcare provider's signature in section 4. Ensure that the date, medical office, and phone number are also entered.
8. After completing all sections (1-4), review the form for accuracy and completeness to avoid any delays in processing.
9. Finally, save your changes, download the completed form, or print it for submission as needed.

Complete your Arizona WIC Milk Alternative Request Form online today to access the benefits you need.