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Medical Documentation Form w - PHPA - Maryland

Medical Documentation Form w - PHPA - Maryland 2025

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The document is a Medical Documentation Form required for WIC (Women, Infants, and Children) to request exempt infant formula or WIC-eligible nutritional products based on specific medical diagnoses. It outlines the necessary information for patient identification, medical conditions, and food restrictions, emphasizing that non-specific symptoms do not qualify for special formula requests. The form also details the types of WIC foods available and their monthly allotments for different categories of participants.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (43 Votes)
2014	4.5 Satisfied (64 Votes)
2011	4.9 Satisfied (43 Votes)

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What formula does WIC cover in Maryland?

Effective 1/29/2025, the Maryland WIC Program will implement a change to our contract formulas. Similac Advance and Similac Isomil will continue to serve as the primary contract infant formulas in Maryland. No medical documentation is needed for WIC participants to be issued primary contract infant formulas.

What is the income limit for WIC in Maryland?

Income eligibility for the WIC program is determined using income standards as prescribed under Section 9(b) of the Richard B. Russell National School Lunch Act (42 USC 1758(b)). The income limit is 185 percent of the Federal poverty guidelines, as adjusted.

How does WIC work in Maryland?

WIC Maryland The Women, Infant and Children (WIC) program provides healthy supplemental food and breastfeeding support to eligible pregnant women, nursing mothers, infants and children up to age five. Maryland WIC focuses on better nutrition and a brighter future.

What does WIC provide in Maryland?

Types of Cows Milk Whole, reduced , low-, or nonfat. Cultured milk. Evaporated. Dry. Lactose-reduced and lactose-free milk. Acidified milk. Shelf stable.

Why does WIC only give Enfamil?

Authorized Foods WIC Benefits Dairy products, including milk, cheese, soy milk, whole milk yogurt, and tofu.

What milk does WIC cover in Maryland?

If you are eligible, you will receive nutrition information, breastfeeding support, referrals to other services, and foods such as: whole grain bread, tortillas, and brown rice. fruits and vegetables. dried canned beans and peas. peanut butter. cereal, milk, and 100% juice. eggs and cheese. baby food and baby cereal.

How to get WIC to change formula?

If you think your baby has a medical condition, please contact your babys health care provider to determine the issue and decide on an appropriate formula. WIC will need a completed Formula and Food Request Form from the babys health care provider for special formulas that require a medical diagnosis for issuance.

Medical Documentation Form w - PHPA - Maryland 2025

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