Get Fl Dh 3075 2018-2026

The FL DH 3075 form is essential for individuals seeking assistance through the Florida WIC Program. Properly completing this form helps ensure eligibility and access to vital nutritional services. This guide will walk you through each section step-by-step, making the process clear and straightforward.

Follow the steps to successfully complete the FL DH 3075 form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Indicate whether the client is eligible for Healthy Start by checking ‘Yes’ or ‘No’. Leave blank if the client has not been screened.
3. Enter the client's name and birth date as required.
4. Optional: Fill in the client's sex, address, phone number, city, zip code, and social security number. Include the name of the parent or guardian for infants and children.
5. Select the appropriate section for the client's category (Pregnant Women, Breastfeeding or Postpartum Women, Infants and Children less than 24 months, or Children 2 to 5 years). Provide the necessary height, weight, hemoglobin or hematocrit values, and corresponding dates as specified.
6. Check any identified health problems relevant to the client. It is advisable to refer clients to the WIC program regardless of health issues identified.
7. If nutrition counseling is requested, check the appropriate box and specify the diet prescription or order.
8. Fill in the health professional’s signature and title, as well as the office address and phone number. Ensure to use an office stamp where required.
9. Provide the completed form to the client or their parent/guardian, or alternatively, mail or fax the form to the local WIC agency as indicated on the form.

Complete your FL DH 3075 form online today to ensure timely access to WIC services.