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Get VA WIC-395 2014

Sy (343.9) Cystic Fibrosis (277.0) Developmental Sensory/Motor Delays (783.4) Failure to Thrive (783.41) Gastro Esophageal Reflux (530.81) Heart/Circulatory (390-459) Specify Malabsorption Syndromes (579.9) Prematurity (765.20) and/or Low Birth Weight (765.1) Other Medical Diagnosis w/ ICD Code: *Symptoms such as spitting up, milk/formula intolerance, picky eater, constipation, cramps, fussiness, or gas are not considered acceptable medical diagnoses and will not be approved by WIC for issuanc.

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