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INFANTSIllinois WIC Formula and Medical Nutritional PrescriptionThis form must be completed by a healthcare provider, in its entirety, to receive Medically Prescribed Formula. Patient Name Birthdate:

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What is wic form illinois pdf?

The WIC form Illinois PDF is a document used to apply for the Women, Infants, and Children (WIC) program in Illinois, which provides nutritional assistance and health education to eligible women, infants, and children.

Who is required to file wic form illinois pdf?

Individuals who are pregnant, breastfeeding, or have children under the age of five, and meet certain income and residency requirements, are required to file the WIC form Illinois PDF to receive benefits.

How to fill out wic form illinois pdf?

To fill out the WIC form Illinois PDF, gather necessary information such as personal details, income verification, family size, and health information. Complete the form accurately and submit it to the local WIC clinic.

What is the purpose of wic form illinois pdf?

The purpose of the WIC form Illinois PDF is to enroll eligible participants in the WIC program, ensuring they receive essential nutritional assistance, health screenings, and education.

What information must be reported on wic form illinois pdf?

The WIC form Illinois PDF typically requires personal identification details, income information, family composition, health status, and any special dietary needs.

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