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How to use or fill out pa wic application with our platform
- Click ‘Get Form’ to open the PA WIC application in the editor.
- Begin by entering the client’s first and last name along with their birth date. This information is crucial for identifying the applicant.
- Next, fill in the parent or caregiver's name. Ensure accuracy as this will be used for communication regarding the application.
- In section one, specify the formula or fortifier requested, including the amount needed per day and intended length of use. If applicable, indicate if tube feeding is required.
- For qualifying medical conditions, provide the necessary ICD-9 code that justifies the prescription of the requested formula or fortifier.
- Indicate any restricted foods by checking 'Yes' or 'No', and specify which foods should not be received from WIC along with the length of restriction.
- Finally, ensure all signatures are completed by a healthcare provider before submitting your application.
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See more pa wic application versions
We've got more versions of the pa wic application form. Select the right pa wic application version from the list and start editing it straight away!
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2009 | 4 Satisfied (41 Votes) |
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