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State of CaliforniaHealth and Human Services Agency Department of Health Services WIC Supplemental Nutrition Branch WIC PEDIATRIC REFERRAL Health Care Provider: Please provide the information requested

How to fill out wic pediatric referral

How to Fill Out WIC Pediatric Referral:

1. Obtain the WIC pediatric referral form from your local WIC agency or download it online.
2. Fill in your personal information, including your name, address, phone number, and any other required contact information.
3. Provide the relevant details of your child, such as their name, date of birth, and medical history, if applicable.
4. Indicate the reason for the referral, whether it is for a specific medical condition, nutritional concerns, or any other relevant factors.
5. If you have a healthcare provider who has recommended the referral, include their name, contact information, and any additional details they may have provided.
6. If you don't have a healthcare provider, you can request assistance in finding one from the WIC agency.
7. Ensure that all the information provided is accurate and up-to-date before submitting the form.

Who Needs WIC Pediatric Referral:

1. Parents or guardians of infants or young children who have identified health or nutritional concerns may need a WIC pediatric referral.
2. Children who have been diagnosed with a medical condition that requires specialized dietary support, such as food allergies, growth issues, or developmental delays, may also need a referral.
3. Some WIC programs may require a referral for all infants and children entering the program, regardless of their health status, to ensure appropriate and individualized support is provided.
4. If you suspect that your child may have specific dietary or nutritional needs, it's advisable to seek a WIC pediatric referral to receive expert guidance and support from healthcare professionals and nutritionists.

For pdfFiller’s FAQs

What is wic pediatric referral?

WIC pediatric referral is a process where healthcare providers refer patients to the Women, Infants, and Children (WIC) program for nutrition assistance and support.

Who is required to file wic pediatric referral?

Healthcare providers such as doctors, nurses, and social workers are required to file WIC pediatric referrals for their patients.

How to fill out wic pediatric referral?

To fill out a WIC pediatric referral, healthcare providers must complete the necessary form provided by the WIC program and submit it to the appropriate WIC office.

What is the purpose of wic pediatric referral?

The purpose of WIC pediatric referral is to connect eligible individuals with nutrition education, counseling, and assistance with obtaining nutritious foods.

What information must be reported on wic pediatric referral?

The WIC pediatric referral form typically requires information such as the patient's demographics, medical history, and nutritional needs.

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