Get 703b Miwic Infant Child Med Doc-no Headerdoc - Dhd2

Filling out the 703B MIWIC Infant Child Med Doc-no Headerdoc - Dhd2 form online is a crucial process for ensuring that infants and children receive the necessary medical nutrition support. This guide will provide you with step-by-step instructions to help you navigate through the form easily.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the document and open it for editing.
2. Begin by filling in the WIC clinic name and address. This information identifies where the client is receiving services.
3. Provide the WIC contact person's name, phone number, and fax number for any necessary follow-up or questions.
4. In the client section, enter the first and last name of the infant or child along with their birthdate, ensuring accuracy to avoid any processing issues.
5. For infants, specify the qualifying medical condition from the provided list and the requested infant formula. Indicate the prescribed daily amount and the physical form of the formula: powder, concentrated, or ready-to-feed.
6. Detail the instructions for preparation and use of the formula and specify the duration for which the medical documentation is valid.
7. If applicable, indicate any supplemental foods allowed for infants and mark any restrictions on specific food items.
8. For children, similarly identify the qualifying medical condition and requested WIC formula or medical food. Include the prescribed amount and any additional instructions or restrictions.
9. For additional substitutions like whole milk, cheese, or soy beverage, check the appropriate boxes and specify amounts if necessary.
10. Indicate the allowable supplemental foods for children and mark any restrictions on specific items.
11. In the instructions/comments section, provide any additional information or specific needs for the client.
12. Secure the required signature from the health care provider along with their printed name, medical office or clinic details, telephone number, and address.
13. Finally, save your changes, download a copy of the completed form, print it out for physical submission, or share it as necessary.

Complete your documents online today to ensure timely support for infants and children in need of medical assistance.