WIC Offers a Variety of Specialty Formulas and Medical Foods
A healthcare professional licensed to write medical prescriptions is required to provide a completed copy of the WIC Medical Documentation Form to the Wyoming WIC Program. Completed forms may be submitted via fax or email to the local WIC office.
Each form must include the following:
- Medical determination of the underlying condition that justifies the need for prescribed product/infant formula;
- Name of the prescribed product/infant formula;
- Amount of product/infant formula that you are prescribing;
- Length of time the product/infant formula should be provided to the WIC participant;
- Indication of food restrictions or contraindications; and
- Signature of healthcare professional, date, and contact information.