Severe food allergies requiring the use of an elemental formula.Inborn errors of metabolism & metabolic disorders.Qualifying Medical Diagnoses Guide for Special Formulas & Medical FoodsĮxamples of Qualifying Medical Conditions Physician must authorize the issuance of any tofu or soy milk to children.Can ONLY be signed by a physician, physician assistant, or nurse practitioner.Must specify foods allowed for all clients on special formulas (age 6 months & older).Original signature, date and contact information of the requesting health care provider.Length of time (1-6 months) the prescribed WIC formula and/or supplemental food is required by the participant.Qualifying condition(s) for issuance of WIC formula prescribed and/or supplemental food authorized and ICD-9/ICD-10 code.Must be prescribed in ounces (reconstituted fluid) per day Name of authorized WIC formula or WIC-eligible medical food.The new requirements for GA WIC approved special formulas and medical foods include: Children receiving milk substitutions of soy beverage, tofu, or extra cheese.Allowable supplemental foods to be provided in addition to the formula, for those participants receiving exempt or specialty infant formula or WIC eligible medical food.Any infants receiving non-contract/exempt or specialty infant formula or WIC eligible medical food.Medical documentation is required in the following situations:.This will also ensure that there is appropriate justification for the use of special formulas & medical foods.
The goal of the new medical documentation requirements is to improve communication and coordination of care between WIC, the family, and the medical home. Medical documentation ensures that you have approved the issuance of special formulas & medical foods that are appropriate for your patient’s specific medical needs. Contact your closest health department/WIC clinic, visit the WIC website at.To access the GA WIC referral and medical documentation forms, and other WIC resources: Please use Georgia WIC Referral Form for referrals. How to I refer my patients or provide a WIC perscription? They must be reassessed for eligibility every six months. Children may be eligible for WIC up to five years of age.Infants may remain on the WIC program until their first birthday.Breastfeeding women may remain on the program for up to one year after delivery (if they continue to breastfeed).Postpartum women may continue (if still eligible) until six months postpartum.Prenatal women can stay on the WIC program throughout their pregnancy until six weeks postpartum.How long will participants receive WIC Services The vouchers are then redeemed by the participant through an approved vendor. These vouchers specify which foods the recipient is to receive. The participant receives monthly food vouchers from their local health departments. WHEN AND HOW DOES THE PARTICIPANT RECEIVE WIC VOUCHERS?
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