Get Ca Cdph 247a 2010-2025
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How to fill out the CA CDPH 247A online
The California Department of Public Health form CDPH 247A is an important document used for pediatric referrals in the WIC program. This guide will provide you with clear instructions and support for completing the form accurately and efficiently online.
Follow the steps to successfully complete your CA CDPH 247A form.
- Press the ‘Get Form’ button to download the form and open it for editing.
- In Section I, enter the patient’s name, WIC ID number, height, weight, and BMI details. Ensure all measurements are recorded within the last 60 days.
- Provide the patient's date of birth and hemoglobin or hematocrit test results. Include the lab result date for the test and record the lead test result if applicable.
- Indicate if the patient’s immunizations are up-to-date and note the measurement date.
- Complete the breastfeeding assessment by selecting the appropriate option that reflects the patient's feeding status.
- If applicable, check the box in Section I for a soy request and provide any conditions that justify this request.
- In Section II, fill in the diagnosis and prescription details related to any therapeutic formula or medical food. Include the duration and amount prescribed.
- List any WIC food restrictions applicable to the patient’s diagnosis by checking the relevant boxes.
- Provide health insurance information and check any applicable actions taken regarding insurance claims.
- Finish the form by entering the health professional's name, signature, medical office information, phone number, and the date.
- Once all sections are filled out, you can save your changes, download, print, or share the completed form.
Complete your CA CDPH 247A form online to ensure a smooth process for pediatric referrals.
The maximum income limit to qualify for WIC varies by state, but it generally aligns with 185% of the federal poverty level. This limit is designed to help low-income families access nutritious foods and health services. For detailed information related to your state and CA CDPH 247A, it’s best to consult your local WIC office. They can provide personalized assistance and clarify any questions you may have.
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