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Submit your completed form or letter to usda by: To start the document, use the fill camp; This form must be completed by a medical provider, in its entirety, to receive medically prescribed formula. Web illinois wic formula and medical nutritional prescription. Formula prescription casein hydrolysate nutramigen w/enflora lgg (powder) pregestimil (powder) alimentum (powder) alimentum (rtf) amino acid based elecare.
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Web below is a list of all wic (special supplemental nutrition program for women, infants, and children) documents available to order. Web women and their children who are: Personally identifiable information is used to determine wic services (e.g., certification/enrollment and food Web call and schedule an appointment and find out what papers or documents you need to bring with you..
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• two current paycheck stubs or public aid card • birth certificate Web to apply for wic benefits, bring the following to a wic location: Patient name (last) (first) birthdate: Web if an item meets the guidelines and is not on the approved food list, you may complete a upc submission request following the steps below. Casein hydrolysate premature &.
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