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Prod ID Product RFO Description 1. Qualifying Conditions Staff Guidance Manufacturer/ Packaging 161 (CI) Cyclinex- 2 (14.1 oz. Powder) 59.00 Special Medical Conditions - Metabolic: Non-essential amino acid free with added L- carnitine and taurine; vitamins and mineral content to compensate for nutrient losses due to nitrogen-scavenger medications and a low protein diet; Nutritionally incomplete; not intended as a sole source of nutrition.

1 Tbsp = 8

RFO is calculated based on mixing to 30cal/oz

Allergens by Nature: Soy 2. HHH Syndrome (ornithine translocase deficiency- hyperornithinemia, hyperammonemia, homecirtrullinuria) 3. Defects in urea cycle enzyme 4. Gyrate atrophy of the choroid and retina Limitations: Can only issue to children 1 year old to 5 years old and women.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Abbott 6 cans/case unflavored 64 (CI) Duocal (14.1 oz. Powder) 160.00 Modular: 4.9 cal/g, high-calorie, carbohydrate and fat with no protein, sucrose, fructose, or lactose; Nutritionally incomplete; contains 35% MCT.

Add 2 scoops to 4oz water. 1 scoop = 5g, 25 cal 1 Tbsp = 8.5g

Allergens by Nature: N/A 1. Conditions where a high-energy, low-fluid, low-electrolytes diet is indicated 2. Protein-restricted diets 3. Disorders of protein and amino acid metabolism 4. Malabsorptive states 5. Modular diets 6. Catabolic states (e.g. burns, trauma, post- operative stress) Limitations: Can only issue to infants, 6-12 months and children through 5 years old.

Requirements: Modular formulas must be approved by District Nutrition Director or State WIC Office Nutricia 6 cans/case unflavored 65 (CI) Elecare Infant DHA/ARA (14.1 oz. Powder) 95.00 Elemental/Amino Acid: 20 cal/oz; hypoallergenic amino acid-based; for oral or tube feeding; does not contain milk or soy protein, fructose, galactose, or lactose; contains 33% MCT oil.

Similar to Alfamino, Neocate Infant DHA/ARA, Neocate Syneo, and PurAmino.

Mix 2 fl oz water with 1 scoop (9.4 g)

Allergens by Nature: Soy 1. Cow’s milk protein allergy (CMPA) 2. Multiple food allergies 3. Eosinophilic GI disorders 4. Malabsorptive conditions 5. Short bowel syndrome (SBS) 6. Food protein-induced enterocolitis syndrome (FPIES) Limitations: Can only issue to infants and children through 23 months old.

Recommendations: A protein hydrolysate (Alimentum, generic hypoallergenic, Extensive HA, Nutramigen, Pepticate, or Pregestimil) is recommended before issuing unless medically contraindicated. Abbott 6 cans/case unflavored 144 (CI) EleCare Junior (14.1 oz. Powder) 62.00 Elemental/Amino Acid: 30 cal/oz; Nutritionally complete; hypoallergenic amino acid-based; for oral or tube feeding; does not contain milk or soy protein, fructose, galactose, lactose; contains 33% MCT oil. Contains added DHA and lutein.

Similar to Alfamino Jr., Neocate Jr. and Puramino Jr.

Allergens by Nature: Soy 1. Cow’s milk protein allergy (CMPA) 2. Multiple food allergies 3. Eosinophilic GI disorders 4. Malabsorptive conditions 5. Short bowel syndrome (SBS) 6. Food protein-induced enterocolitis syndrome

Limitations: Can only issue to children 12 months to 5 years.

Abbott 6 cans/case unflavored vanilla