WIC-11 dot 2026

1. Click ‘Get Form’ to open the WIC-11 dot in the editor.
2. Begin by entering the WIC ID# at the top of the form. This is essential for identification purposes.
3. Fill in the patient’s name, date of birth, current height/length, and current weight in the designated fields.
4. Provide the parent or caregiver's name and today's date to ensure proper documentation.
5. In section 1, specify any alternative formula if needed, along with the requested formula and amount. Choose between physical forms like powder or concentrate.
6. Indicate the intended length of use for the formula and check any qualifying conditions that justify medical need in section 2.
7. Answer whether the patient can receive supplemental foods by checking 'Yes' or 'No' and select applicable food items from the list provided.
8. Complete any additional comments or instructions before signing off as a healthcare provider at the bottom of the form.

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