Dh 3110 Medical Documentation For Formula And Food Florida Wic
Florida Wic Form. At this visit, the household income and the medical/nutrition status of each applicant will be reviewed. Bureau of wic program services.
Dh 3110 Medical Documentation For Formula And Food Florida Wic
Web contact the florida wic program. At this visit, the household income and the medical/nutrition status of each applicant will be reviewed. Wic is funded by the united states department of agriculture (usda) and is administered in florida by the department of health. Or office of the assistant secretary for civil rights fax: Web the florida wic program supports the american academy of pediatrics’ statement on breastfeeding and the use of human milk. The local wic office will give you a date and time for a wic certification visit. Bureau of wic program services. 4052 bald cypress way, bin a16. Form completion is not a confirmation of medicaid approval. Web fax for all wic clinics.
Yes no for wic office use only:date of wic certification appointment ______________ Form completion is not a confirmation of medicaid approval. 4052 bald cypress way, bin a16. *the durable medical equipment (dme) provider may request additional information from the ordering physician, such as but. Medical documentation for formula and food form 146 kb pdf. Medical documentation for formula and food form, fillable version 176 kb pdf. 4052 bald cypress way, bin a16. Bureau of wic program services. Web contact the florida wic program. At this visit, the household income and the medical/nutrition status of each applicant will be reviewed. Wic is funded by the united states department of agriculture (usda) and is administered in florida by the department of health.
