Get Ca Cdph 247a 2016-2025

Filling out the CA CDPH 247A form efficiently can assist individuals in utilizing the California WIC Program. This guide provides clear instructions on completing each section of the form online to ensure accurate submission and to promote ease of understanding for all users.

Follow the steps to complete the CA CDPH 247A form online.

1. Press the ‘Get Form’ button to access the CA CDPH 247A form and open it for editing.
2. In Section I, enter the patient’s first and last name. Ensure that the name is correctly spelled as it appears on legal documents.
3. Provide the current height or length measured within the last 60 days in inches and, if applicable, ounces. Next, enter the current weight in pounds and ounces, also measured within the last 60 days.
4. Fill in the patient's date of birth and record the current body mass index (BMI) along with its percentile. Include the measurement date.
5. Include the required hemoglobin or hematocrit test result, ensuring it is performed within the last 12 months if normal, or every 6 months if abnormal. Record the result along with the lead test recommendations.
6. Indicate if the patient's immunizations are up-to-date by selecting yes, no, or not available.
7. Assess the breastfeeding status by marking the appropriate option, along with the date if breastfeeding has been discontinued.
8. In Section II, complete all boxes if a therapeutic formula is prescribed. Provide the diagnosis and indicate any food restrictions by checking the boxes for foods that are not appropriate.
9. Specify the type and amount of the prescribed formula or medical food, including the duration of the prescription.
10. Fill in the health coverage details and check off actions taken regarding the patient's insurance and potential referrals.
11. Review and comment on any additional information that may be necessary for the patient’s situation.
12. Complete the health professional's details, including their name, phone number, signature, clinic name and location, and today's date.
13. Once all sections are filled out, you can save changes, download, print, or share the completed form.

Start completing the CA CDPH 247A online now to ensure timely submission.