This section provides essential materials for WIC staff. Available resources include forms, formula handbook, data catalog, policy manual, nutrition risk criteria, and materials for local agency WIC Coordinators, such as monitoring and semiannual report forms.
WIC staff
Forms
- Application - EN and SP
- Card inventory - monthly report
- Complaint or incident report
- Computer down kit
- Confidentiality agreement
- Conflict of interest
- Data request form
- Direct bill
- Health assessment
- Letter of ineligibility - EN and SP
- Letter of ineligibility - SP
- Medical documentation
- No proof and temporary (income) certification - EN and SP
- No proof and temporary (income) certification - SP
- Rights, responsibilities and consent - EN and SP
- Rights, responsibilities and consent - signature- EN and SP
- Verification of certification (VOC)
- Violation
- WIC proof of lawful presence attestation form
- WIC proof of lawful presence attestation form - SP
Formula handbook
• 1. Contact information and resources
• 2. How to conduct a search in the product guide
• 3. WIC formula overview - flowchart
• 4. Policy reminders
• 5. Calculation guidance and examples
• 6. Formula and nutritional issuance grid
• 7. Formula provided by Idaho WIC
• 8. Product guide
• 9. Rounding up procedure
• 10A. McKesson ordering protocol
• 10B. McKesson ordering QRC
• Direct bill training
• Formula Index of Changes
• Medical documentation form training
Program data catalog
Policy manual
Policy manual - full version with supplements
Nutrition risk criteria
Anthropometric 100
- 101 Underweight (women)
- 103 Underweight / at risk of underweight (I & C)
- 111 Overweight (women)
- 113 Obese (children 2-5 years)
- 114 Overweight / at risk of overweight (I & C)
- 115 High weight-for-length (I & C under 24 months)
- 121 Short stature / at risk of short stature (I & C)
- 131 Low maternal weight gain
- 133 High maternal weight gain
- 134 Failure to thrive
- 135 Slowed / faltering growth pattern
- 141 Low birth weight / very low birth weight
- 142 Preterm or early term delivery
- 152 Low head circumference
- 153 Large for gestational age
Clinical health and medical 300
- 301 Hyperemesis gravidarum
- 302 Gestational diabetes
- 303 History of gestational diabetes
- 304 History of preeclampsia
- 311 History of preterm or early term delivery
- 312 History of low birth weight
- 321 History of spontaneous abortion, fetal or neonatal loss
- 331 Pregnancy at a young age
- 332 Short interpregnancy interval
- 334 Lack of or inadequate prenatal care
- 335 Multi-fetal gestation
- 336 Fetal growth restriction
- 337 History of birth of a large for gestational age infant
- 338 Pregnant woman currently breastfeeding
- 339 History of birth with nutrition related congenital or birth defect
- 341 Nutrient deficiency or disease
- 342 Gastrointestinal disorders
- 343 Diabetes mellitus
- 344 Thyroid disorders
- 345 Hypertension and prehypertension
- 346 Renal disease
- 347 Cancer
- 348 Central nervous system disorders
- 349 Genetic and congenital disorders
- 351 Inborn errors of metabolism
- 352.1 Infectious diseases - acute
- 352.2 Infectious diseases - chronic
- 353 Food allergies
- 354 Celiac disease
- 355 Lactose intolerance
- 356 Hypoglycemia
- 357 Drug nutrient interactions
- 358 Eating disorders
- 359 Recent major surgery, physical trauma, burns
- 360 Other medical conditions
- 361 Mental illnesses
- 362 Developmental, sensory or motor disabilities interfering with the ability to eat
- 363 Pre-diabetes
- 371 Nicotine and tobacco use
- 372 Alcohol and substance use
- 381 Oral health conditions
- 382 Fetal alcohol spectrum disorders
- 383 Neonatal abstinence syndrome
Dietary 400
- 401 Failure to meet dietary guidelines for americans
- 411 Inappropriate nutrition practices for infants
- 411.1 Justification - inappropriate nutrition practices for infants
- 425 Inappropriate nutrition practices for children
- 425.1 Justification - inappropriate nutrition practices for children
- 427 Inappropriate nutrition practices for women
- 427.1 Justification - inappropriate nutrition practices for women
- 428 Dietary risk associated with complementary feeding practices
Environment and other factors 500+
- 501 Possibility of regression
- 502 Transfer of certification
- 601 Breastfeeding mother of infant at nutritional risk
- 602 Breastfeeding complications or potential complications (women)
- 603 Breastfeeding complications or potential complications (infant)
- 701 infant up to 6 months old of WIC mother or of a woman who would have been eligible during pregnancy
- 702 Breastfeeding infant of woman at nutritional risk
- 801 Homelessness
- 802 Migrancy
- 901 Recipient of abuse
- 902 Woman or infant / child of primary caregiver with limited ability to make appropriate feeding decisions and / or prepare food
- 903 Foster care
- 904 Environmental tobacco smoke exposure
Nutrition risk criteria toolkit
WIC coordinators
Clinic site modification
Forms
New employee training checklists
Training lead information
- Anthropometrics
- Assign benefits
- Baby behavior
- Basic nutrition
- Breastfeeding
- Card and cardholders
- Care plan I
- Care plan II samples
- Case study appendix answers for trainer
- Child nutrition
- Computer system (WISPr)
- Confidentiality
- Customer service communication
- Directions
- Eligibility
- Food list
- Food packages
- Health and nutrition assessment
- Health and nutrition assessment advanced
- Health and nutrition assessment advanced sample
- Hematology
- Index of changes - guidebooks
- Issuing benefits
- Overview
- Participant centered education (PCE)
- Postpartum nutrition
- Prenatal nutrition
- Referrals
- Special authorization
MOUs, consents, & releases | confidentiality guidance