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Effective October 2016Medical Documentation Form for Special Needs Food Packages Client Name: Date of Birth:WIC Client ID:Please fully complete every section (17) to avoid delays in issuance. Please
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01
To fill out the Arizona Department of Health form, follow these steps:
02
Begin by downloading the form from the official Arizona Department of Health website.
03
Read the instructions carefully to understand the purpose of the form and the information required.
04
Gather all the necessary supporting documents or information that may be required to complete the form.
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Start filling out the form by entering your personal details, such as name, address, contact information, etc.
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Provide accurate and complete information as requested in each section of the form.
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If there are any specific sections that you are unsure about, consult the instructions or seek assistance from the Arizona Department of Health.
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Once you have completed filling out the form, submit it as per the instructions provided, either electronically or by mail.
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Keep a copy of the filled-out form and any supporting documents for your records.
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If required, follow up with the Arizona Department of Health to ensure the form has been received and processed.

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