Get the free FORM 213 6 WIC Clinic: Medical Documentation Fax #: WIC ... - healthandwelfare idaho
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Medical Documentation for Women, Infants and Children (WIC) The Medical Documentation form (on the back) is the . Only. Acceptable form by the Idaho WIC program needed:
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How to fill out form 213 6 wic
How to fill out form 213 6 wic?
01
Obtain the form: You can access form 213 6 wic from the nearest WIC (Women, Infants, and Children) center or download it from their official website.
02
Provide personal information: Fill in your full name, address, contact details, and any other information required in the designated sections of the form.
03
Include household details: Indicate the total number of people living in your household, their names, ages, and relationships to you.
04
Provide income information: Specify your income sources, including any wages, benefits, or assistance received by you or any member of your household.
05
Declare nutritional risk: Answer the questions regarding your or your child's medical conditions, dietary restrictions, or other factors that may qualify for WIC assistance.
06
Sign the form: Review the filled-out form, ensuring all information is accurate and complete. Sign the form and date it before submitting it to the WIC office.
Who needs form 213 6 wic?
01
Pregnant women: Pregnant women who meet the income eligibility criteria and have nutritional risk factors may need to fill out form 213 6 wic to access the WIC program's benefits for themselves and their unborn child.
02
New mothers: Mothers who have recently given birth may need to complete form 213 6 wic to apply for WIC benefits to support their postpartum nutritional needs and their infant's health.
03
Infants and young children: Parents or legal guardians of infants or young children (up to the age of five) who face nutritional risk factors and meet the income requirements may need to fill out form 213 6 wic to receive WIC assistance in ensuring their child's healthy growth and development.
04
Caregivers: If you are a caregiver responsible for the nutrition and well-being of a qualifying pregnant woman, new mother, or young child, you may also need to complete form 213 6 wic on their behalf to apply for WIC benefits.
Remember, it is always advisable to consult the nearest WIC office or refer to their official resources for specific guidance and assistance in accurately filling out form 213 6 wic.
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