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This document serves as a health care referral for infants under 1 year old and children aged 1 to 5 years, as part of the New Jersey Women, Infants, and Children (WIC) program. It includes necessary information, medical history, and contact details for various WIC offices in New Jersey. The form also outlines the requirements for measurements and blood tests to assess nutritional risks.

How to fill out wic health care referral

How to fill out wic health care referral

1. Gather necessary information: Obtain personal details like name, address, and phone number.
2. Complete the income assessment: Provide proof of income such as pay stubs or tax returns.
3. List the household members: Include names and ages of all family members living in the household.
4. Provide medical information: Include any existing medical conditions or special dietary needs.
5. Obtain the healthcare provider's details: Fill in the name, address, and phone number of the healthcare provider.
6. Sign and date the form: Ensure you sign at the designated area and include the date.

Who needs wic health care referral?

1. Pregnant women seeking nutritional support.
2. Postpartum women requiring healthcare assistance.
3. Breastfeeding mothers looking for support and resources.
4. Infants and children under the age of five who need health care referrals.

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What is wic health care referral?

WIC Health Care Referral is a process through which WIC participants are connected to health care services that meet their needs, ensuring they receive appropriate medical support and nutritional guidance.

Who is required to file wic health care referral?

WIC health care referrals are typically required to be filed by WIC staff on behalf of participants who need additional health care services, such as medical evaluations and assessments.

How to fill out wic health care referral?

To fill out a WIC health care referral, one must complete the designated referral form, providing necessary participant information, the specific health services required, and signatures from both the WIC staff and the participant.

What is the purpose of wic health care referral?

The purpose of the WIC health care referral is to facilitate access to essential health services for participants, promoting better health outcomes for women, infants, and children.

What information must be reported on wic health care referral?

The information typically required on a WIC health care referral includes participant identification details, the services being referred for, the reason for the referral, and any relevant medical history.