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Get NJ WIC-11 2016-2024

Ompleted form to the WIC clinic or have your patient return the document to the WIC Clinic. 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. Re-authorization is required every three months. No au.

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