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Utah WIC Program Formula and Food Authorization Infants up to 12 Months of Age Please complete each appropriate section below or formula/foods cannot be issued. A. Patients Name: Patients DOB: Parent/Guardian
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Infants up to 12 refers to children up to the age of 12 years old.
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Information such as the child's name, age, date of birth, and any other relevant details must be reported on infants up to 12.
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