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California wic referral form

Program wic 2025

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The document is a referral form for the California WIC Program, designed for health care providers to assess the health status of pregnant and postpartum women. It collects essential patient information, including medical history, current medications, and health conditions, to facilitate nutritional counseling and determine eligibility for program benefits. The document also includes non-discrimination policies in accordance with USDA regulations.

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Click ‘Get Form’ to open the WIC Referral document in the editor.
Begin by entering the patient's name, address, and telephone number in the designated fields. Ensure all information is accurate to avoid delays.
Fill out the woman's current measurements including height, weight, hemoglobin, and hematocrit levels. Be sure to include measurement dates for reference.
Indicate any medical conditions affecting the woman by checking the appropriate boxes. This helps assess her health status effectively.
List any current medications or supplements prescribed to the patient in the provided section. This information is crucial for nutritional counseling.
Complete the local WIC agency details and ensure that a healthcare provider signs and dates the form before submission.

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2014	4.9 Satisfied (210 Votes)
2010	4 Satisfied (38 Votes)

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What is the WIC program short for?

Women, Infants and Children (WIC) - Acronyms.

What do you get with WIC in New Mexico?

New Mexico WIC provides foods high in nutrients such as calcium, vitamin D, and protein that are important for mothers and young children. WICs goal is to ensure the health of participants and families by providing a variety of healthy foods and supporting nursing.

What does WIC give you for a baby?

WIC cannot provide infant foods until your baby turns 6 months old. 6-11 months: At this age breastmilk or formula are still the primary source of nutrition for your baby. In addition your infant will receive infant foods (infant cereal and infant fruits vegetables).

What does Ohio WIC cover?

WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. WIC provides free healthy foods, breastfeeding support, nutrition education and referrals to other services, to support you and your family.

What are the WIC food packages?

The WIC food packages provide supplemental foods designed to address the specific nutritional needs of income-eligible pregnant, breastfeeding, and non-breastfeeding postpartum individuals, infants, and children up to five years of age who are at nutritional risk.

ca wic referral form

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What is free with WIC?

WIC provides free, healthy foods and personalized nutrition education, breastfeeding support, referrals to other services and more. WIC now uses Electronic Benefit Transfer (EBT) cards! The WIC EBT card works just like a debit card. You can also save time with virtual appointments in many locations.

What does WIC provide in NM?

The New Mexico WIC Program provides free healthy foods, ideas for healthy eating and maintaining good health habits, support for nursing families, and connects families with other community services.