Get Wic 395

The Wic 395 form is essential for requesting special food packages for participants of the Virginia Women, Infants, and Children (WIC) Program. This guide provides a clear and comprehensive approach to filling out the Wic 395 online, ensuring that users understand each component of the form.

Follow the steps to complete the Wic 395 form effectively.

1. Press the ‘Get Form’ button to obtain the Wic 395 and open it in the editing interface.
2. Fill in the participant's name in the designated field. Ensure you have the correct spelling, as it is crucial for identification.
3. Enter the date of birth of the participant in the provided space. This ensures that the request is appropriately categorized by age.
4. Specify the special formula or medical food requested. It is essential to be precise to facilitate the needs of the participant.
5. Indicate the required daily amount of whole milk for women and children over the age of 2. This figure should reflect the actual needs of the participant.
6. Select the intended length of use from the options provided: 1 month, 3 months, 6 months, or 1 year (for infants only). Choose the most appropriate duration based on the participant's needs.
7. Provide medical documentation that supports the need for the requested formula or whole milk. This may include a brief description of the medical diagnosis.
8. Review the list of supplemental foods. Indicate any foods that should not be given to the participant based on their medical diagnosis by checking the corresponding boxes.
9. Print or stamp the name of the health care provider in the designated area. Follow this with their signature to validate the request.
10. Fill in the healthcare provider's address, telephone number, and fax number for contact purposes.
11. Add the date that the form is completed to finalize the submission process.
12. If the request is being faxed, ensure it is sent directly to the local WIC clinic of the participant. Once filled out, users can save changes, download, and share the form as needed.

Start filling out the Wic 395 online to ensure the participant receives the necessary support.