Get the free WIC Referral Form - Hawaii Department of Health - coverageforall

STATE OF HAWAII DEPARTMENT OF HEALTH WIC SERVICES BRANCH CERTIFICATION, ELIGIBILITY & COORDINATION WIC Referral (Fax to 586-8189) Applicant Name: Last Apt No. Home. Telephone #: First Street Mailing

How to fill out wic referral form

How to fill out WIC referral form:

1. Begin by obtaining the WIC referral form. This can usually be found at a local WIC clinic or online on the official WIC program website.
2. Take the time to read the instructions provided on the form. This will help ensure that you understand the requirements and fill out the form correctly.
3. Start by providing your personal information on the form. This typically includes your name, address, phone number, and date of birth. Make sure to write legibly and double-check for any errors.
4. Next, you may be required to provide information about your household. This could include the names and ages of all household members, as well as their relationship to you. Supplying accurate information will help determine the eligibility of your household for the WIC program.
5. Some referral forms may also ask for income information. This is used to assess income eligibility for the program. Be prepared to fill in details about your income sources, such as employment, government benefits, or other sources.
6. Additionally, you might need to provide information regarding your current health status or any medical conditions of family members in your household. This information is important for the WIC program to deliver the appropriate services and support.
7. In the case that you have already received medical screenings, bring the results along with the completed referral form to WIC clinic appointments.
8. After filling out the form, review it carefully to ensure all information is entered correctly and matches any supporting documents or paperwork you are required to submit.
9. Finally, submit the completed WIC referral form to your local WIC clinic or follow the instructions provided on how to submit the form electronically. Double-check the submission process to make sure it is done correctly.

Who needs the WIC referral form?

The WIC referral form is typically needed by individuals who are looking to apply for the WIC program. This program is designed to provide nutrition education, healthy food, and support to low-income pregnant women, new mothers, and young children who are at nutritional risk. To determine eligibility for WIC services, individuals are often required to complete a referral form, providing their personal and household information. It is important to note that eligibility criteria may vary by location, so individuals should check with their local WIC program for specific requirements.

For pdfFiller’s FAQs

What is wic referral form?

The WIC referral form is a document used to refer individuals to the Women, Infants, and Children (WIC) program for nutritional support.

Who is required to file wic referral form?

Healthcare providers, social workers, and community organizations are typically required to file WIC referral forms.

How to fill out wic referral form?

The WIC referral form can be filled out by providing the required information about the individual being referred, including their contact information and reasons for the referral.

What is the purpose of wic referral form?

The purpose of the WIC referral form is to connect individuals in need of nutritional support with the WIC program, which provides resources and assistance to women, infants, and children.

What information must be reported on wic referral form?

The WIC referral form typically requires information about the individual being referred, such as their name, contact information, medical history, and reasons for the referral.

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