WIC Referral Forms for Health Care Providers
PHFE WIC offers many open-source resources to dietitians, researchers, and other maternal and child health professionals to spark collaboration to improve health outcomes.
Medical Documentation
To be eligible for WIC services, all WIC participants must provide certain medical documentation, including documentation for formula for premature and medically fragile infants. This includes any special formulas and nutritionals for older children.
WIC Eligible Formulas
WIC provides contracted formulas as part of an agreement that is a federally mandated cost containment system. For infants and children who require a medically necessary (therapeutic) formula, WIC can assist the provider in obtaining certain formulas for their patients.
WIC Referral Guide
Please refer to this pamphlet to learn how WIC promotes evidence-based practices. It includes information about WIC eligibility, breastfeeding support, nutrition services, and more.
WIC Referral Forms
Medical documentation is required for WIC participation. Please use this form to assist patients with WIC eligibility. The information provided will be used by WIC staff to assess your patient’s health status and provide nutritional counseling if they qualify for the program.
