- #Approved wic formula download
- #Approved wic formula free
This describes the reason the change in food or formula is needed.
The WIC Formula and Food Authorization Form must have a diagnosis checked by the prescribing authority. These milks can be supplied at the request of the participant or guardian.
Do I need a FAFAF for goat milk or soy milk or lactose free milk?. At this time, the USDA has not approved coconut, almond or rice milk for WIC benefits. Can I get coconut milk, rice or almond milk with a FAFAF?. If your doctor recommends one of these supplements for yourself or your child, please feel free to contact a WIC nutritionist so that the FAFAF can be completed correctly. Following the age of 2, and for women, whole milk can only be prescribed along with a medical supplemental food such as Pediasure, Ensure, or Carnation Instant Breakfast. Children up to the age of 2 automatically receive whole milk from WIC unless a specific request is made by the child’s guardian. All other WIC foods are supplied by means of monthly benefits loaded on your eWIC card which can be used at many major supermarkets around the state. Some formula and medical foods for infants and toddlers must be ordered through a special pharmacy and picked up monthly at the WIC clinic. What about foods that are not found in the store?. Infants whose sole source of nutrition is formula because of tube feeding or similar medical issues may receive more formula if the doctor marks no baby foods and no infant cereal on the FAFAF. Infants who are able to take food by mouth will not receive more formula than the 32 ounces per day maximum provided by WIC. Can I get more formula if my doctor marks “no baby foods”?. If your doctor marks less than this amount, you will not be able to receive more than your doctor has marked. If your doctor marks 32 ounces on the WIC form, you can adjust the amount up to this quantity by talking to your WIC nutritionist. The maximum amount of formula that WIC can provide is 32 ounces per day. What amount of formula or food should my doctor write in?. Please contact your WIC clinic to see if it is available in your language. This form is available in multiple languages. Contact us for details about what needs to be filled out by telephone 80 or text 38. If your doctor has told you that you cannot bring your infant or child into the WIC clinic for their application appointment, your doctor will need to complete this form and fax it to the WIC clinic or you can bring it with you for the appointment. Have a WIC participant who needs a lactation consult or additional breastfeeding support? Please complete the referral form, link below, and email to We will work with the clinic to assist the participant.Referral-Data-Form Download Health Data Referral Form Medical Documentation Form (1-26-21) WIC Lactation Referral Form Medical documentation is required for alternative contract formulas, therapeutic formulas, and any special accommodations to the standard food package. The Medical Food Breakdown (9-1-21) form lists commonly prescribed formulas, cans sizes, yields and maximum amounts. Participants must have a current prescription on file at the WIC clinic to receive a therapeutic formula. The WIC Medical Documentation Form provides common qualifying diagnosis. Therapeutic Formulas are available upon request for participants with a qualifying diagnosis. Similac for Spit-Up Similac Sensitive Similac Total Comfort Therapeutic Formulas Similac Advance Similac Soy Isomil Alternative Contract Formulas Children one year and older must have a prescription to receive standard formula. Standard formulas are for infants less than one-year-old and do not require medical documentation. WIC food packages target specific nutrients, including protein, calcium, potassium, fiber, vitamins A and C, and iron.įor a list of WIC approved foods, please visit the Approved WIC Foods page. WIC food packages are based on the Dietary Guidelines for Americans recommendations and established dietary recommendations for infants and children.
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