Get Fl Dh 3110 2022-2026

The FL DH 3110 form is a crucial document for the Florida WIC Program that enables users to request specific formulas and supplemental foods based on qualifying medical conditions. This guide will help you understand the form's components and provide step-by-step instructions for completing it online.

Follow the steps to complete the FL DH 3110 online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling out Section A with the client's name and date of birth, followed by specifying the formula requested and the amount per day in ounces. If the formula is for an infant under 12 months, check the appropriate box for hypoallergenic or specialized formula options.
3. For the length of use, select the number of months for which the formula is needed, ensuring it does not exceed 12 months. Document any qualifying medical conditions, including height and weight measurements if applicable.
4. In Section B, select the appropriate WIC supplemental foods for infants aged 6 to 11 months. Indicate any medical constraints by checking the relevant options for food provisions.
5. For women or children aged 1 year and older, specify if formula or a nutritional product is required, and indicate preferences for milk types and any foods to omit.
6. Complete Section C with the healthcare provider's information, including their name, credentials, address, phone number, fax number, and signature.
7. After all sections are completed, review the information for accuracy, then save changes, download, print, or share the completed form as necessary.

Complete your FL DH 3110 online today to ensure the necessary nutritional support for your needs.