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Prod ID Product RFO Description Qualifying Conditions Staff Guidance Manufacturer/ Packaging 60 (CI) Boost Kid Essentials 1.5 (8 oz. RTF) 8.00 Increased Calorie Supplement: 45 cal/oz, lactose free; nutritionally complete, contains MCT oil.
Similar to Pediasure 1.5
Allergens by Nature: Milk Weight/length or BMI <10% and/or downward crossing of 2 major percentiles along with one or more of the following diagnoses: 1. Faltering weight or inadequate weight gain 2. Failure to Thrive (FTT) or malnutrition 3. Increased calorie needs 4. Tube feeding* 5. Oral motor feeding issues/aversions* 6. Developmental delays (sensory & motor)* 7. Prematurity (<37 weeks)/LBW *Authorization is not dependent on growth meeting parameters outlined above when diagnosis is present. See Note on page 24 for additional information. Limitations: Can only issue to children 12 months to 5 years. Nestle 24 containers/case vanilla chocolate strawberry 61 (CI) Boost Kid Essentials 1.5 w/Fiber (8 oz. RTF) 8.00 Increased Calorie Supplement: 45 cal/oz, lactose free; nutritionally complete; for oral or tube feeding; contains MCT oil; 2.1 g fiber/8 oz container.
Similar to Pediasure 1.5 w/ Fiber
Allergens by Nature: Milk Increased fiber needs AND Weight/length or BMI <10% and/or downward crossing of 2 major percentiles along with one or more of the following diagnoses: 1. Faltering weight or inadequate weight gain 2. Failure to Thrive (FTT) or malnutrition 3. Increased calorie needs 4. Tube feeding* 5. Oral motor feeding issues/aversions* 6. Developmental delays (sensory & motor)* 7. Prematurity (<37 weeks)/LBW *Authorization is not dependent on growth meeting parameters outlined above when diagnosis is present. See Note on page 24 for additional information. Limitations: Can only issue to children 12 months to 5 years old. Nestle 24 containers/case vanilla 58 Boost Plus (8 oz. RTF) 8.00 Increased Calorie Supplement: 45 cal/oz, lactose-free, high-calorie; nutritionally complete. 14g protein and 360 calories per container
Similar to Ensure Plus.
Allergens by Nature: Milk, Soy Increased calorie needs with one or more of the following diagnoses: 1. Pregnancy with underweight BMI pre- pregnancy 2. Fetal growth restriction 3. multi-fetal pregnancy 4. Underweight BMI during breastfeeding Limitations: Can only issue to women. Nestle 24 containers/case, vanilla 174 (CI) Calcilo- XD (12.4 oz. Powder) 89.00 Special Medical Conditions - Hypercalcemia: 20 cal/oz; lactose and vitamin D free, low-calcium. Nutritionally incomplete: nutritionally complete for all nutrients except calcium, phosphorus and vitamin D.
Add 1 unpacked level scoop (8.6 g) to 2 fl oz of water
Allergens by Nature: Milk 1. Osteopetrosis 2. William's Syndrome 3. Hypercalcemia and hyperparathyroidism (need a low-calcium, vitamin D-free formula) Limitations: Can only issue to infants and children. Abbott 6 cans/case unflavored