Virginia wic form 2026

1. Click ‘Get Form’ to open the Virginia WIC-395 request form in the editor.
2. Begin by filling out Section A, which requires the participant's name, date of birth, and parent/caregiver’s name. Ensure all information is accurate for proper processing.
3. In Section B, input the current anthropometric data including weight, length/height, Hgb/Hct levels, and the date assessed. This information is crucial for determining eligibility.
4. Proceed to Section C to select any alternative routine infant formulas if necessary. Check the appropriate boxes based on the participant's needs.
5. If special formulas are required, complete Section D with product names and diagnosis details. Be sure to include ICD codes where applicable.
6. In Section E, indicate whether to issue full provision of age-appropriate foods or modifications as needed. This section helps tailor the food package.
7. Finally, fill out Section F regarding the length of use and provide health care provider information in Section G. Ensure all signatures are included before submission.

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