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ARKANSAS DEPARTMENT OF HEALTH WIC PROGRAM SPECIAL FORMULA REQUEST WIC may provide the following formulas with documented medical reason/diagnosis. Supplemental foods will only be issued with approval
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How to fill out wic-51 special formula request
How to fill out WIC-51 special formula request:
01
Obtain the WIC-51 special formula request form from your local Women, Infants, and Children (WIC) office or download it from their website.
02
Fill out the top section of the form, which includes your name, address, WIC ID number, and contact information.
03
Provide information about the person for whom the special formula is being requested. This includes their name, date of birth, and any medical conditions or specific dietary needs they have.
04
Indicate the reason for the special formula request by selecting the appropriate option. This could be due to a medical condition, allergies, or other dietary requirements.
05
If the special formula is being requested due to a medical condition, provide the name of the medical provider who diagnosed the condition and their contact information.
06
Specify the name of the requested special formula and any additional information, such as the specific brand or type of formula required.
07
If any attachment or supporting documentation is required, make sure to include it with your request. This could include a medical prescription or a letter from a medical provider explaining the need for the special formula.
08
Sign and date the form, certifying that the information provided is true and accurate to the best of your knowledge.
Who needs WIC-51 special formula request:
01
Individuals with infants or young children who have medical conditions or specific dietary needs that require a special formula.
02
Parents or guardians of infants or young children who are allergic to regular infant formula or have difficulty digesting it.
03
Families who are enrolled in the WIC program and have been advised by a medical professional to use a specific special formula for their child's health requirements.
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What is wic-51 special formula request?
The WIC-51 special formula request is a form used to request special baby formulas for infants who have specific medical or dietary needs.
Who is required to file wic-51 special formula request?
Parents or legal guardians of infants who have special medical or dietary needs are required to file the WIC-51 special formula request.
How to fill out wic-51 special formula request?
To fill out the WIC-51 special formula request, parents or legal guardians must provide information about the infant's medical or dietary needs and submit the form to the appropriate WIC office.
What is the purpose of wic-51 special formula request?
The purpose of the WIC-51 special formula request is to ensure that infants receive the appropriate special baby formula to meet their specific medical or dietary needs.
What information must be reported on wic-51 special formula request?
The WIC-51 special formula request must include information about the infant's medical condition, dietary restrictions, and any special formula recommended by a healthcare provider.
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