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Special Formula Request Form WIC-396 Purpose: To complete an original Special Formula Request Form WIC-396 to order special formula from the Community Action Program Distribution Center. The CAP Distribution
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How to fill out special formula request form

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How to fill out a special formula request form:

01
Start by reading through the instructions provided with the form. It's important to understand the requirements and any specific information that needs to be included in the request.
02
Begin by filling out the personal details section of the form. This typically includes your name, contact information, and any identification numbers or codes that may be required.
03
Move on to the specific details section where you will need to provide information related to the special formula you are requesting. This can include the purpose of the formula, any relevant medical conditions or dietary requirements, and any supporting documentation or medical reports that may be necessary.
04
Ensure that you provide accurate and complete information. Double-check all the details before submitting the form, as any errors or missing information may result in delays or rejection of the request.

Who needs a special formula request form?

01
Individuals with specific medical or dietary needs: Special formula request forms are typically required for individuals who have specific medical conditions, allergies, or dietary requirements that necessitate the use of specialized formulas. These can include infants or children with food allergies or individuals with certain medical conditions that require specialized nutritional support.
02
Parents or guardians: If the special formula is being requested for a child or dependent, the parent or guardian will typically need to fill out the form on their behalf.
03
Medical professionals: In some cases, medical professionals may also be required to complete or provide certain information for the special formula request form. This can include doctors, nutritionists, or other healthcare providers who can attest to the medical necessity of the formula.
Overall, anyone who requires a special formula due to specific medical or dietary needs will need to fill out a special formula request form in order to obtain the necessary support or assistance.
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The special formula request form is a document used to request a specialized formula for a specific purpose.
Individuals or organizations in need of a specialized formula are required to file the special formula request form.
To fill out the special formula request form, you must provide detailed information about the formula needed and the purpose for which it will be used.
The purpose of the special formula request form is to ensure that specialized formulas are provided to those who need them for specific purposes.
The special formula request form must include information about the formula needed, the purpose for which it will be used, and any relevant supporting documentation.
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