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Wisconsin Department of Health Services

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WIC Forms and Publications 

The following forms used by local WIC projects are available in PDF and Word-fillable formats.   

Breastfeeding

Title

Number

Format

Breast Pump Order Request

F-40052A

Word-fillable

Breast Pump Release Form DPH 40105 Word-fillable
Breast Pump Release Form DPH 40105H Word-fillable
Breast Pump Release Form DPH 40105S Word-fillable

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Last Revised:  March 19, 2013