Get For Wic Office Use Only:

Filling out the For WIC Office Use Only: form is a crucial step in the process of securing WIC services. This guide provides clear and supportive instructions to help users accurately complete the form online.

Follow the steps to successfully fill out the form.

1. Press the ‘Get Form’ button to retrieve the form and open it in the online editor.
2. Indicate if the client is eligible for Healthy Start by checking 'Yes' or 'No.' If the client has not been screened, leave this section blank.
3. Enter the client's name and birth date in the provided fields.
4. Fill in optional information such as the client’s sex, mailing address, phone number, city, zip code, and parent’s or guardian’s name for infants and children.
5. Complete the appropriate section based on the client category: Pregnant Women, Breastfeeding or Postpartum Women, Infants, or Children under five years. Provide height, weight, and relevant dates as specified.
6. For health issues, check any applicable boxes that pertain to the client’s medical condition or concerns.
7. If nutrition counseling is required, check the box and specify the diet prescription or order requested.
8. In the shaded area at the bottom, ensure the health professional’s signature, title, office address, and phone number are completed. Affix the office stamp in the designated space.
9. Once the form is fully completed, provide it to the client or parent/guardian for their WIC certification appointment, or send it via mail or fax to the local WIC agency.

Complete the required documents online to ensure a smooth WIC application process.