Get Medical Documentation For Formula And Food Form

This guide provides comprehensive instructions for completing the Medical Documentation For Formula And Food Form online. Designed to assist users of all experience levels, this step-by-step approach ensures clarity and efficiency in filling out the necessary information.

Follow the steps to complete the form accurately

1. Press the 'Get Form' button to obtain the Medical Documentation For Formula And Food Form and open it for completion.
2. Provide the client’s name and date of birth in the specified fields. Fill in these sections accurately to ensure proper identification.
3. In the section regarding formulas and food options, indicate whether WIC contract formulas have been tried by selecting 'Yes' or 'No'. If contraindicated, explain the reasoning in the provided space.
4. List the specific formula names required. For each formula, choose whether to request the maximum amount allowed or specify the exact ounces needed per day.
5. If applicable, check the box for issuing supplemental foods for children aged 1 year or older who are prescribed formula. Select any additional WIC supplemental foods required.
6. Specify any modified food packages needed by ticking the appropriate boxes for infants under 1 year or for women/children aged 1 year or older.
7. In the special instructions or additional restrictions section, provide any necessary details relevant to the formula request.
8. Indicate the length of use for the requested formula, choosing from the provided options. Include any qualifying medical conditions in the specified section.
9. Input anthropometric data, including height and weight, ensuring that details meet the requirements for failure to thrive if applicable.
10. Complete the milk substitutes and options section if relevant, detailing any specific requirements for children aged 1 to less than 2 years or women/children aged 2 years or older.
11. Ensure the form is completed with the signature and contact details of the health care provider, including an office stamp if required.
12. After completing the form, review all information for accuracy. Save changes, download, print, or share the form as necessary.

Complete your medical documentation efficiently by filling out the form online today.