Get the free WIC Medical Form Infants & Children

NEW YORK STATE DEPARTMENT OF HEALTH DIVISION OF Nutrition WIC Use:Date Mailed/ Glendale Recast Date WIC ID #WIC MEDICAL REFERRAL FORM FOR INFANTS and CHILDREN Child's Last Name (Print): Child's First

How to fill out wic medical form infants

How to fill out wic medical form infants

1. To fill out the WIC medical form for infants, follow these steps:
2. Obtain a copy of the WIC medical form for infants.
3. Start by entering the basic information of the infant, such as their name, date of birth, and gender.
4. Provide the contact information of the parent or guardian.
5. Next, fill out the infant's medical history, including any previous diagnoses, allergies, or medications.
6. Answer the questions related to the infant's growth and development, such as their weight, height, and milestones.
7. If applicable, provide information about the infant's feeding habits, breastfeeding status, or formula usage.
8. Complete any additional sections or questions specifically mentioned in the form.
9. Review the form for completeness and accuracy.
10. Sign and date the form to certify its accuracy.
11. Submit the filled-out WIC medical form for infants to the appropriate authority or WIC office.

Who needs wic medical form infants?

1. WIC medical form for infants is needed by parents or guardians of infants who are participating in the WIC (Women, Infants, and Children) program. WIC is a federal assistance program that provides nutrition and health support to low-income pregnant women, new mothers, and young children.

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What is wic medical form infants?

WIC medical form for infants is a document used to report the medical information of infants participating in the Women, Infants, and Children (WIC) program.

Who is required to file wic medical form infants?

Parents or guardians of infants participating in the WIC program are required to file the medical form for infants.

How to fill out wic medical form infants?

The WIC medical form for infants can be filled out by providing the necessary medical information of the infant, including immunizations, growth chart, and any medical conditions.

What is the purpose of wic medical form infants?

The purpose of the WIC medical form for infants is to ensure that infants participating in the WIC program are receiving appropriate medical care and monitoring.

What information must be reported on wic medical form infants?

The WIC medical form for infants must include information such as immunizations, growth chart data, medical conditions, and any special dietary requirements.