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Appendix 2.016C Effective May 2014 D.C. WIC Medical Documentation & Referral Form for WOMEN, INFANTS & CHILDREN This form is used for referring clients to WIC or special dietary requests. Complete
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How to fill out dc wic form
How to Fill Out DC WIC Form:
01
Start by gathering all the necessary documents and information. You will need personal identification, proof of address, proof of income, and proof of residency in Washington, DC.
02
Visit a local WIC office in DC to obtain the WIC application form. You can also download the form from the official DC WIC website.
03
Fill out the personal information section of the form accurately. This includes providing your name, date of birth, contact details, and social security number.
04
Next, provide information about your household members who will be participating in the WIC program. Include their names, dates of birth, and relationship to you.
05
Proceed to the income section of the form. Provide details about your household's income, including wages, child support, SNAP benefits, and any other sources of income.
06
In the residency section, indicate your address and other relevant details to confirm your eligibility for the DC WIC program.
07
Complete the nutrition risk assessment portion of the form. Answer the questions about your current health status, pregnancy, breastfeeding, or any medical conditions that may require special dietary considerations.
08
If you have any specific dietary restrictions or allergies, make sure to mention them in the appropriate section.
09
Once you have filled out all the required sections of the form, review it carefully to ensure accuracy and completeness.
10
Sign and date the form. If you require any assistance or have questions, ask a WIC staff member at the office.
Who Needs DC WIC Form:
01
Pregnant women in Washington, DC who want to access nutritional support for themselves and their unborn child.
02
New mothers who are breastfeeding and need assistance with essential nutrients for themselves and their baby.
03
Infants and children up to the age of five who require extra nutrition during their crucial growth and development stages.
04
Low-income individuals or families in DC who meet the income guidelines and have a nutritional need for WIC benefits.
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What is dc wic form?
The DC WIC form is a form used to apply for the Women, Infants, and Children program in the District of Columbia.
Who is required to file dc wic form?
Pregnant women, new mothers, infants, and children under the age of five are required to file the DC WIC form.
How to fill out dc wic form?
To fill out the DC WIC form, applicants must provide information about their income, household size, and nutritional needs.
What is the purpose of dc wic form?
The purpose of the DC WIC form is to determine eligibility for the WIC program and to provide access to nutritious foods and nutritional counseling.
What information must be reported on dc wic form?
Information such as income, household size, and nutritional needs must be reported on the DC WIC form.
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