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Appendix 2.016C Effective May 2014 D.C. WIC Medical Documentation & Referral Form for WOMEN, INFANTS & CHILDREN This form is used for referring clients to WIC or special dietary requests.

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This guide provides step-by-step instructions on how to complete the Dc Wic Form online efficiently. Whether you are new to the process or need a refresher, this comprehensive overview is designed to assist everyone in filling out the necessary information accurately and swiftly.

Follow the steps to complete the Dc Wic Form online.

  1. Click the ‘Get Form’ button to access the form and open it in the designated online editor.
  2. Begin by entering the patient's name and date of birth in the appropriate fields at the top of the form. Ensure all information is spelled correctly.
  3. Next, fill in the address, city, and zip code of the patient, followed by the parent or caregiver's name and their telephone number.
  4. In the medical data section, input the relevant dates and measurements for length/height and weight. Make sure to add the dates when these measurements were taken.
  5. For women (pregnant, nursing, or postpartum), indicate whether they are pregnant, their estimated date of delivery, and feeding plan. Specify if they have a multi-fetal gestation.
  6. For infants and children, fill out the birth history section, including birth weight, birth length, and weeks of gestation.
  7. If special medical foods or formulas are required, provide the name of the formula, amount needed, and length of time for use, along with any additional instructions.
  8. Indicate any foods that should not be provided by WIC and outline the reasons for these restrictions clearly.
  9. Once all sections are completed, review the form to check for accuracy and clarity in the information provided.
  10. Finally, save your changes to the document. You can download, print, or share the completed form as needed.

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To be income-eligible for WIC: However, you do not have to be on a public assistance program to qualify for WIC.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal assistance program of the Food and Nutrition Service (FNS) of the United States Department of Agriculture (USDA) for healthcare and nutrition of low-income pregnant women, breastfeeding women, and children under the age of ...

Proof of Income- If you have no income or no proof of your income, you can fill out a form stating you have no income. However, within one month you must show proof of income or proof that you do not have income so you can still apply for WIC services.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal assistance program of the Food and Nutrition Service (FNS) of the United States Department of Agriculture (USDA) for healthcare and nutrition of low-income pregnant women, breastfeeding women, and children under the age of ...

Any type of unemployment benefit received is considered income for the purpose of determining WIC income eligibility as required by 7 CFR 246.7(d)(2)(ii)(F).

Moms who aren't breastfeeding receive WIC benefits for six months after your baby is born. Families receive WIC benefits until your child turns five.

This form maybe used to refer patients to the WIC Program and to communicate changes in patient health information. The information provided on this form will be used by a WIC nutritionist to determine nutrition care and provide nutrition counseling.

WIC EBT is an electronic system that replaces paper vouchers with a card for food benefit issuance and redemption at authorized WIC grocery stores. Management Information Systems (MIS) of FNS WIC provides technical assistance and project oversight for State Agency partnership activities.

To apply for the WIC Program in the District of Columbia: Call your local WIC site. For a list of site locations visit dcwic.org/wic-locations. WIC staff will ask you a few questions to determine if you are eligible.

Proof of income. If you get food stamps (SNAP), Medicaid, or cash assistance (TANF), you're automatically eligible for WIC from the financial perspective. If you aren't automatically eligible, bring proof of income for all members of your household.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232