WIC-11 dot 2025

See details

4.6 out of 5

41 votes

The document outlines the medical documentation requirements for WIC (Women, Infants, and Children) formula and approved foods for infants, children, and women in New Jersey. It emphasizes the responsibility of healthcare providers to oversee the issuance of exempt infant formula and nutritional supplements, requiring updated medical documentation every three months. The form includes sections for patient information, requested formula details, qualifying conditions for WIC eligibility, and a list of approved supplemental foods. It also specifies that no authorization is needed for certain formulas and provides guidelines for various participant categories.

Here's how it works

01. Edit your wic11 login online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send wic 11 via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out WIC-11 dot with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

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

Start using our platform today to easily fill out your WIC-11 dot form online for free!

See more WIC-11 dot versions

We've got more versions of the WIC-11 dot form. Select the right WIC-11 dot version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2023	4.6 Satisfied (41 Votes)
2022	4.9 Satisfied (59 Votes)
2016	4 Satisfied (22 Votes)
2013	4.8 Satisfied (53 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What does WIC provide that Snap does not?

SNAP: Allows for a wider variety of foods with fewer restrictions. WIC: Covers only specific foods to ensure nutritional support for pregnant women and young children.

What are the disadvantages of the WIC program?

Prior research has identified potential barriers to WIC participation; these include WIC clinic access (Woelfel et al., 2004), language and cultural barriers (Johnson et al., 2013; United States Department of Agriculture, 2023a; United States Department of Agriculture, 2023b), negative experience with staff members (

What does WIC not cover?

Not Allowed Enzymes, herbs, or botanicals. Oral rehydration fluids or electrolyte solutions. Flavoring or thickening agents. Feeding utensils or devices (e.g., feeding tubes, bags, pumps) designed to administer a WIC-eligible formula.

How is WIC different from EBT?

WIC provides: Supplemental foods high in nutrients needed for growth and development. Nutrition education to improve diet and health habits. Information, support, and encouragement for breastfeeding. Referrals for other health services.

What does WIC give you while pregnant?

Some of the foods covered by WIC include: Fresh fruits and vegetables. Whole grains, such as bread, rice, and tortillas. Dairy products like milk, cheese, and yogurt. Protein sources like eggs, beans, peanut butter, and canned fish. Iron-fortified cereals. Vitamin C-rich fruit juices.

wic11

Wic 11 dot pdf What does WIC give a 6 Month old in Tennessee Tn WIC for 1 year Old TN WIC online renewal Tennessee WIC packages WIC grocery pickup What do you get in WIC WIC vouchers

What does WIC cover in Walmart?

SNAP helps low-income families stretch their grocery budget each month. WIC provides specific healthy foods and nutrition support to pregnant people, new parents, children under five, and foster families with foster children under five. Research shows these programs work.

How much baby food does WIC give per month?

Snapshot of WIC Food Packages for Infants Fully Formula (FF) FedFully Breastfed (BF) WIC Formula A: 823 fl. oz. reconstituted liquid concentrate B: 896 fl. oz. reconstituted liquid concentrate Infant cereal 24 oz. Infant food fruits and vegetables2 256 oz. Infant food meat 77.5 oz.1 more row