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WIC Resources for Children and Youth
with Special Health Care Needs

Listed below are fact sheets, forms and other information about WIC's services to children and youth with special health care needs (CYSHCN). For more information about special health care needs, consult the website for Wisconsin's CYSHCN Program.

Waisman Center CYSHCN-WIC Toolkit Website (Exit DHS)

A WIC formulas and medical foods for infants and children (P-40023) (PDF, 131 KB)
B WIC services for special health care needs (P-40139) (PDF, 78 KB)
C WIC prescriptions and clinical data form for infants (F-44024D) (DOC, 23 KB)
D WIC prescriptions and clinical data form for children (F-44024B) (DOC, 34 KB)
E WIC prescriptions and clinical data form for women (F-44024A) (PDF, 25 KB)
F WIC formulas for infants, standard (P-40077A) (PDF, 23 KB)
G WIC formulas for infants, prescription required (P-40077B) (PDF, 45 KB)
H WIC formulas and medical foods for children, prescription required (P-40077C) (PDF, 48 KB)
I WIC medical foods for women, prescription required (P-40077D) (PDF, 38 KB)
J Sample prescription clarification letter to health care providers (PDF, 21 KB)
K Guidance for the maternal and pediatric referral/communication form (PDF, 11 KB)

Special Nutrition Needs

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Last Revised:  July 03, 2014