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Medical documents pdf 2026
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- Click ‘Get Form’ to open the medical documents PDF in the editor.
- Begin with Section A, 'Patient Information.' Enter the patient's name and date of birth accurately to ensure proper identification.
- Move to Section B for 'Exempt Formula and WIC Supplemental Foods.' Specify the formula requested, length of use, and prescribed amount in ounces per day. Include any special instructions or comments as needed.
- In Section C, check the appropriate boxes for soy beverage or tofu if applicable for milk protein allergy diagnosis.
- Complete Section D by providing your signature, date, and contact information as the health care provider.
- Finally, ensure that Sections E and F are filled out by the participant/parent/caregiver and WIC staff respectively before submission.
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