MT WIC Infant Formula Request Form 2021-2025 free printable template

WIC Infant Formula Request Form All requests are subject to WIC staff approval. Sections A, B, C or D, and E must .be completed for consideration. A. Participant Information: Name:DOB:Today's Date:B.

How to fill out wic formula prescription form

How to fill out MT WIC Infant Formula Request Form

1. Obtain the MT WIC Infant Formula Request Form from your local WIC office or download it from the WIC website.
2. Fill out your personal information, including your name, address, phone number, and WIC ID number.
3. Indicate the baby's date of birth and any relevant health information.
4. Specify the type and quantity of infant formula needed, as per your healthcare provider's recommendations.
5. If applicable, provide any special instructions or considerations related to the baby's dietary needs.
6. Review the form for accuracy and completeness.
7. Submit the completed form either in person at the WIC office or via the designated method provided by WIC.

Who needs MT WIC Infant Formula Request Form?

1. Infants who are enrolled in the WIC program and require supplemental formula due to insufficient breast milk or specific medical conditions.
2. Parents or guardians of infants who need to request formula through the WIC program.
3. Healthcare providers who recommend formula for infants participating in WIC.

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What is MT WIC Infant Formula Request Form?

The MT WIC Infant Formula Request Form is a document used by participants in the Montana WIC (Women, Infants, and Children) program to request specific infant formula or brand substitutions that are not automatically provided.

Who is required to file MT WIC Infant Formula Request Form?

Participants of the Montana WIC program who need specific types or brands of infant formula not available through standard distribution must file the MT WIC Infant Formula Request Form.

How to fill out MT WIC Infant Formula Request Form?

To fill out the MT WIC Infant Formula Request Form, participants should provide their personal information, specify the infant's needs, indicate the desired formula or brand, and submit it to the appropriate WIC office for review and approval.

What is the purpose of MT WIC Infant Formula Request Form?

The purpose of the MT WIC Infant Formula Request Form is to ensure that breastfeeding and formula-feeding infants receive the appropriate nutritional support by allowing participants to request specific formulas that meet their infants' health needs.

What information must be reported on MT WIC Infant Formula Request Form?

The information that must be reported on the MT WIC Infant Formula Request Form includes the participant's name, WIC identification number, infant's name, specific formula or brand requested, and any medical or dietary needs relevant to the request.