WIC-395 Form PDF Details

The Commonwealth of Virginia's Department of Health extends a focused effort towards promoting breastfeeding through its Women, Infants, and Children (WIC) Program, while also acknowledging the necessity for formula feeding in certain scenarios. With an exclusive contract with Abbott Nutrition, Virginia WIC mandates the use of Similac Advance and Similac Soy Isomil for formula-fed infants, restricting the utility of formulas from other manufacturers unless medically warranted. When a specialized formula or food is deemed necessary for medical reasons, healthcare professionals are encouraged to fill out the Virginia WIC 395 form to request a special food prescription for the infants, children, and women under their care. Accommodating the nutritional needs and medical conditions of each participant, the form facilitates a process to ensure that all eligible individuals receive not only the specialized nutritional products they require but also continue to have access to standard WIC supplemental foods. This process is upheld through rigorous protocols, requiring the renewal of the WIC-395 form at each certification appointment or whenever a change in the prescription is necessary, ensuring the program's adaptability to the evolving health needs of its participants. Details regarding formula issuance, including Ready To Feed (RTF) options, standard formula amounts, and policy-driven exceptions, are meticulously outlined, providing clear guidance for healthcare providers. This structure underscores Virginia WIC’s commitment to supporting the health and nutrition of vulnerable populations by bridging the gap between medical necessity and nutritional assistance.

QuestionAnswer
Form NameWIC-395 Form
Form Length3 pages
Fillable?Yes
Fillable fields148
Avg. time to fill out30 min 25 sec
Other namesform wic 395 form, wic 395, wic 395 form virginia, wic form 2021

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