Get the free WIC Medical Formula and Nutritionals Request Form - CDPH

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CLICK to CLEAR FORM FORMULAS AND INELIGIBLE NUTRITIONAL MEMO OF RECEIPTDepartment of Health and Human Services Community Nutrition Services Section (CSS)Memo of Receipt CSS Nutritional Product Order If

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How to fill out wic medical formula and

01

First, gather all the necessary information such as the baby's name, birthdate, and any medical conditions.

02

Next, carefully follow the instructions on the packaging of the formula to ensure proper mixing and preparation.

03

Use clean bottles and nipples to avoid contamination.

04

Measure the correct amount of formula and water as directed on the packaging.

05

Shake or stir the formula well to ensure it is mixed thoroughly before feeding.

Who needs wic medical formula and?

01

WIC medical formula is typically needed for infants and young children who have specific medical conditions that require specialized formula, such as allergies, digestive issues, or failure to thrive.

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What is WIC medical formula?

WIC medical formula is a specialized nutritional product provided by the Women, Infants, and Children (WIC) program to infants and children who have specific dietary needs or health conditions that require supplemental nutrition.

Who is required to file WIC medical formula?

Health care providers or authorized WIC coordinators are required to file for WIC medical formula on behalf of eligible infants and children who meet specific medical criteria.

How to fill out WIC medical formula?

To fill out a WIC medical formula application, you typically need to complete the designated forms provided by WIC, including information about the child's medical condition and nutritional needs, and any supporting documentation from a healthcare provider.

What is the purpose of WIC medical formula?

The purpose of WIC medical formula is to provide necessary nutrition to infants and young children who cannot obtain adequate nutrition from breastfeeding or standard infant formulas due to health issues.

What information must be reported on WIC medical formula?

Information that must be reported on the WIC medical formula includes the child's name, age, medical diagnosis, prescribed formula type, and any recommendations for use from a health care provider.

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