WebReferred to WIC QUESTIONS: 1-888-942-2229 www.wicworks.ca.gov; click Health Care Professionals; then click WIC contacts for MDs. COMMENTS: NAME – MD, PA or NP SIGNATURE - MD, PA or NP MEDICAL OFFICE / CLINIC NAME AND LOCATION OR OFFICE STAMP PHONE NUMBER TODAY’S DATE CDPH 247A PHFE 03/16 WebYou may qualify if you: Are pregnant, breastfeeding, just had a baby (or recent pregnancy loss); or. Have a child or care for a child under age 5; and. Have low-to-medium income …

WIC Pediatric Referral - California

WebQuestion Answer; Form Name: Wic Referral Form: Form Length: 1 pages: Fillable? No: Fillable fields: 0: Avg. time to fill out: 15 sec: Other names: ca cdph 247a, pediatric referral form, ca cdph pediatric, wic referral form california WebUse of this form is required unless the healthexamination report is on an electronic printout from a licensed physician, physician assistant,or other EPSDT provider. Completion of … suffolk park byron bay accommodation

Department of Public Health

Webthe intended recipient, please contact the sender and destroy all copies of the original form. ... CDPH 247A (REV 05/2010) DIAGNOSIS: Prematurity GERD or reflux Food allergy: _____ ... Referred to WIC Pediatric Referral State of California – Health and Human Services Agency California Department of Public Health ... WebWIC requires a completed WIC Medical Documentation Form including an ICD-10 code to coordinate care. WIC professional staff is required to contact the prescribing physician if … WebIf you are not the intended recipient, please contact the sender and destroy all copies of the original form. This institution is an equal opportunity provider and employer. CDPH 247A … suffolk park accommodation