MD WIC Medical Documentation Form 2014 free printable template

Medical Documentation Form This form is federally required to ensure your patient has a medical diagnosis that requires an exempt infant formula/WIC-eligible nutritional or change to the WIC food

How to fill out MD WIC Medical Documentation Form

How to fill out MD WIC Medical Documentation Form

1. Obtain the MD WIC Medical Documentation Form from the local WIC office or download it from the official website.
2. Fill in the patient's personal information, including their name, date of birth, and WIC ID number.
3. Provide details about the medical provider: name, address, phone number, and signature.
4. Indicate the specific medical condition requiring WIC services.
5. Complete the nutritional assessment section based on the patient's health and dietary needs.
6. Attach any relevant medical records or test results that support the need for WIC services.
7. Review the form for accuracy and completeness before submission.
8. Submit the form to the local WIC office either in person or via mail as instructed.

Who needs MD WIC Medical Documentation Form?

1. Individuals who are pregnant, breastfeeding, or have young children (up to age five) and require nutritional assistance through the WIC program.
2. Healthcare providers who need to document a patient's eligibility for WIC services.
3. Families seeking nutritional support and education related to health and wellness for their children.

Instructions and Help about MD WIC Medical Documentation Form

Welcome to the Maryland WIC program WIC is the short name for the special supplemental nutrition program for women infants and children good morning all right you're signed in if you could have a seat over there we'll be with you shortly WIC is federally funded by the United States Department of Agriculture in Maryland it is administered by the Maryland Department of Health WIC services are provided in clinics operated by local health departments and nonprofit health agencies throughout the state WIC is a nutrition and health program for pregnant women new mothers infants and children up to the age of five years along with nutritious foods you'll receive health screenings nutrition education breastfeeding support and referrals to health care and other services WIC foods are prescribed for each person participating in the programs the foods provided are high in protein iron calcium and other vitamins that are critical to proper development of growing bodies and mine good nutrition early in life can prevent serious health problems later on so what foods do weight provide women and children can get milk and cheese eggs beans and peanut butter cereal whole-wheat bread brown rice and soft corn and whole wheat tortillas fruits and vegetables and 100 fruit juice women who are exclusively breastfeeding also get canned fish and breastfeeding support additional options include soy beverage and tofu infants get infant cereals fruits and vegetables and may get infant formula as well stores that except wit can be identified by the Marilyn a whiff accepted here window sign all foods provided by the Maryland WIC program are specific for each individual on the program details about the actual foods you can buy are found in the authorized foods list this list contains descriptions and pictures of the types brands and container sizes of the foods you can buy take time to become familiar with the Maryland WIC authorized foods lists in the clinics you'll receive a personalized shopping list for your family every month your family's benefits are loaded onto one a WIC card benefits will expire, so please keep track of each benefit end date you will need to return to the clinic for nutrition education and to receive additional benefits your e-book card will be provided to you in the clinic you will be asked to select a pin at that time keep your card in a safe place like your wallet or purse keep your card away from magnets and electronics do not leave your card in direct sunlight do not write your PIN on your card do not throw you a WIC card away it can be used a whole time you and your family you see you extend if you have a damage card or would like to change your PIN contact a WIC customer service at 1 800 or WWF YB and ft com now that you know more about Rick's let's go shopping you must have your Maryland a WIC card with you to use your WIC food benefits know your food benefit balance when you go to the store use your family's personalized shopping list and...

People Also Ask about

How much formula does WIC provide in Maryland?

Up to 104 fl oz reconstituted powder can be issued only for qualifying conditions as listed in Policy and Procedure 5.09. 1 IBP-mostly applies to infants that are breastfed and are receiving <14 fl oz of formula from WIC.

What does WIC cover in Maryland?

If you are eligible, you will receive nutrition information, breastfeeding support, referrals to other services, and foods such as: whole grain bread, tortillas, and brown rice. fruits and vegetables. dried canned beans and peas. peanut butter. cereal, milk, and 100% juice. eggs and cheese. baby food and baby cereal.

What is the Maryland WIC app?

The Maryland WIC Mobile App will give WIC participants the opportunity to view upcoming appointments, view food benefits that have been issued to them in the clinic, scan UPCs while shopping at the store to see if the UPC is a WIC Approved item or not, and provide information on locations of WIC Stores and WIC Clinics

How do I check my WIC balance in Maryland?

Call your local WIC Office or 1-800-242-4942 for assistance with your benefits.

Is WIC income based in Maryland?

Income Eligibility Income guidelines are calculated using gross (before tax) income. Check the WIC website for current guidelines. For example, a family of 2 qualifies for benefits if you have a monthly income of less than $2,607.

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What is MD WIC Medical Documentation Form?

The MD WIC Medical Documentation Form is a required form used within the Maryland Women, Infants, and Children (WIC) program to document medical necessity for WIC services and benefits.

Who is required to file MD WIC Medical Documentation Form?

Healthcare providers or organizations participating in the WIC program are required to file the MD WIC Medical Documentation Form for eligible participants to certify their need for specific services.

How to fill out MD WIC Medical Documentation Form?

To fill out the MD WIC Medical Documentation Form, providers should complete all required sections, including participant information, medical assessments, and signatures. The form must be filled accurately and submitted according to the guidelines set by the Maryland WIC program.

What is the purpose of MD WIC Medical Documentation Form?

The purpose of the MD WIC Medical Documentation Form is to establish the medical eligibility of WIC participants and to ensure that they receive the appropriate nutrition and health services based on their specific needs.

What information must be reported on MD WIC Medical Documentation Form?

The information that must be reported on the MD WIC Medical Documentation Form includes participant demographics, medical history, height and weight measurements, nutrition assessments, and provider signatures.