WIC Use Only

Tx WIC Medical Request For Formula/Food Form

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SKU: F13-06-13152

Description

(Rev 12/23) Restricted for WIC use only. This form is designed for WIC staff to provide to WIC clients or Health Care Partners when there is a medical request for a therapeutic formula or a formula request for a child over age 1. It provides a list of formulas WIC provides without a medical request, formulas WIC does not provide, and additional resources for parents.

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