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Get NJ WIC-11 2022-2024

Fax Please complete entire form. Fax or email the completed form to the WIC office or have your patient return the form to the WIC office. Thank You. PLEASE NOTE: It is the responsibility of the health care provider to provide close medical oversight and instructions to participants issued exempt infant formula, WIC-eligible Nutritionals and/or supplemental foods that require medical documentation. This responsibility cannot be assumed by personnel at the WIC State or local agency. Updated Med.

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