Get Medical Documentation Form Doh-4456 - Hocts

Filling out the Medical Documentation Form DOH-4456 - Hocts online is a straightforward process that ensures the proper management of nutritional needs for WIC participants. Follow this guide to understand each section of the form and provide accurate information efficiently.

Follow the steps to complete the Medical Documentation Form DOH-4456 - Hocts online.

1. Click ‘Get Form’ button to obtain the form and open it in the designated online editor.
2. In section A, enter the patient information including the patient's name and date of birth. This information is mandatory for all WIC participants.
3. Proceed to section B to request exempt formula and supplemental foods. Specify the formula requested, the prescribed amount in ounces per day, and the length of use by checking the appropriate boxes.
4. Include any special instructions or comments in the designated area of section B, as well as indicate WIC qualifying medical conditions by checking the appropriate boxes.
5. For infants, ensure to note WIC supplemental foods the patient cannot tolerate by checking the relevant food items specified in the section.
6. If applicable, move to section C to check the boxes for soy beverage and/or tofu, indicating the request for those items for individuals diagnosed with a milk protein allergy.
7. Complete section D by entering the health care provider information, including signature, date, contact details, and printed name.
8. In section E, the participant, parent, or caregiver must provide a signature, date, and their printed name to authorize the request.

Start completing the Medical Documentation Form DOH-4456 - Hocts online for proper nutritional management today.