The Illinois WIC Program uses the WIC Formula and Medical Nutritional Prescriptions Form as its method for communicating and documenting special formula/food needs from the medical home to the WIC agency.
All areas of the form must be completed by a physician or other licensed health care professional authorized to write medical prescriptions under state law and are valid for a maximum of 3 months.
If you have questions, please contact the Bureau of Family Nutrition at (217) 782-2166.
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
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