Kentucky wic form 2026

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The document outlines the procedures and requirements for obtaining medical necessity certifications for formula and WIC food exceptions for children aged 1 to 5. It includes sections for patient information, medical diagnosis, requested formulas, supplemental foods, and healthcare provider details. The form is intended to address specific medical conditions that necessitate special dietary provisions, such as lactose intolerance or failure to thrive, and lists commonly provided formulas and nutritional products available through the WIC program.

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Click ‘Get Form’ to open the Kentucky WIC form in the editor.
Begin by filling out Section A, which requires patient information. Enter the patient's name, date of birth, and the parent or caregiver's name. Include the medical diagnosis that justifies the need for formula or food.
In Section B, specify the medical formula or food requested. Clearly indicate the prescribed amount and any special instructions.
Proceed to Section C to select supplemental foods. If you wish to omit all supplemental foods, check that option; otherwise, check only those foods you want provided.
Finally, complete Section D by having a healthcare provider sign and print their name. Ensure all contact information is accurate before submitting.

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2014	4.8 Satisfied (81 Votes)

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How does WIC work in Kentucky?

WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. 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.

How many years does WIC last?

A TWIC card is valid for five years from the date it is issued to an applicant.

How long do you get WIC in Kentucky?

Families receive WIC benefits until your child turns five.

How long does WIC last in KY?

Moms who are breastfeeding receive WIC benefits for one year after your baby is born. Moms who arent breastfeeding receive WIC benefits for six months after your baby is born.