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Georgia wic 2026
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- Click ‘Get Form’ to open the Georgia WIC Medical Documentation Form in the editor.
- Begin by entering the patient’s first and last name along with their date of birth in the designated fields.
- In Section 1, list any qualifying medical conditions along with their corresponding ICD-9 or ICD-10 codes. This information is crucial for justifying the special formula request.
- Proceed to Section 2 to specify the special formula requested. Fill in the name of the formula, prescribed ounces per day, and select the form type (Powder, Concentrate, or Ready-to-feed).
- Complete Section 3 by indicating if there are any supplemental food restrictions. If none, initial the appropriate line; otherwise, check contraindicated foods as necessary.
- Finally, fill out Section 4 with healthcare provider information including signature and credentials. Ensure all boxes are completed accurately.
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