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ITC WIC SPECIAL FORMULA AUTHORIZATION FORM CHILDREN, WOMEN & HEALTHY INFANTS WIC Staff Name: WIC Phone Number: A. Client Information: Client Name: Client DOB: B. Formulas Previously Tried: Contract
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Children Women & Healthy is a program that provides support and resources for children, women, and families to promote overall health and wellness.
The program administrators or designated representatives are required to file children women & healthy.
Children Women & Healthy forms can be completed online or submitted through a designated portal with all required information.
The purpose of Children Women & Healthy program is to improve the health and well-being of children, women, and families through access to necessary resources and support services.
Information such as demographics, health status, and utilization of services must be reported on children women & healthy forms.
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