Get Ca Cdph 247 2010

The CA CDPH 247 form is essential for health care providers referring pregnant women to the California WIC Program. This guide will help you navigate the process of completing the form accurately and effectively, ensuring that your patient receives the nutrition assistance they need.

Follow the steps to fill out the CA CDPH 247 form accurately and efficiently.

1. Press the ‘Get Form’ button to access the CA CDPH 247 form and open it within your editing environment.
2. Begin by filling in the patient’s name, ensuring you include both the last and first name clearly.
3. Next, provide the patient's complete address, including street, city, and ZIP code.
4. Fill in the patient’s telephone number to ensure they can be contacted.
5. In the section titled 'Woman’s Current (Prenatal)', enter the patient’s height in inches.
6. Input the patient’s weight in pounds and include the measurement date for accuracy.
7. Enter the patient's hemoglobin level, selecting the appropriate checkbox for any relevant medical histories, including diabetes and hypertension.
8. Document any additional medical conditions affecting the patient, ensuring to elaborate if necessary.
9. Record the estimated date of confinement and the patient’s birthdate.
10. Indicate the date when the last pregnancy ended, followed by the gravida and para counts.
11. List the pregravid weight along with details of any current medications or supplements prescribed.
12. Provide any impressions or comments that may assist the WIC Program staff.
13. Fill in the local WIC agency information, including the name of the healthcare provider or clinic and their contact number.
14. Finally, ensure the form is signed by the healthcare provider and include the date of signing.
15. Once all fields are completed, save your changes, and proceed to download, print, or share the completed form as necessary.

Complete your CA CDPH 247 form online today to ensure your patient receives necessary nutritional support.