Get Wic Program Medical Documentation (dhhs 3835)

The WIC Program Medical Documentation (DHHS 3835) is a crucial form for ensuring that infants, children, and women receive the necessary nutritional support through the Women, Infants, and Children (WIC) program. This guide will provide a detailed, step-by-step approach to filling out this form online, making the process accessible and straightforward for all users.

Follow the steps to complete the WIC Program Medical Documentation effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Begin with section A, 'Participant Information'. Fill in the participant’s name, date of birth (DOB), and any medical condition(s) that indicate a need for the prescribed product.
3. Continue to section B, 'Formula/Product'. Here, specify the formula or product prescribed, including the amount prescribed per day, any special instructions for preparation or dilution, and the duration of the prescription, which is limited to infants under 12 months of age.
4. If applicable, also complete section C, 'Supplemental Foods'. Indicate any supplemental foods that the infant should not receive during the duration of the prescription, choosing from the options provided.
5. For users over 12 months of age or women, ensure to fill out section B if a formula/product is prescribed, and section C if whole milk is recommended for a child aged 24 months or older.
6. Finally, proceed to section D, 'Health Care Provider Information'. Here, the healthcare provider must sign, print their name, and include their medical office or clinic address, phone number, fax number, and the date.
7. Once all sections are completed, review the form for accuracy. Save your changes, and then you can download, print, or share the form as necessary.

Complete the WIC Program Medical Documentation online to ensure proper nutritional support for eligible participants.