Page 400

WIC Nutrition Risk Criteria

System Assigned (SA); System or CPA Assigned (SA/CPA); CPA Assigned (CPA); Automatic High Risk* (HR) Code Category [Priority] Risk Criteria/Definition Required Documentation 7

Crossroads. Note: If condition confirmed at certification, document on the Health Information Screen (Health Conditions slider) in Crossroads. Risk Category: Clinical/Health/Medical Code Category/[Priority] Risk Criteria/Definition Required Documentation 301 (SA/CPA) PG [1] Hyperemesis Gravidarum: Severe and persistent nausea and vomiting during pregnancy which may cause more than 5% weight loss and fluid and electrolyte imbalances. NOTE: This criterion is based on a chronic condition, not single episodes. Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. Document on Health Information screen (pregnancy-induced health conditions slider) in Crossroads. 302* (SA/CPA) (HR) PG [1] Gestational Diabetes: Any degree of glucose/carbohydrate intolerance with onset or first recognition during pregnancy. Presence of condition diagnosed and reported by physician or someone working under physician’s orders or as self-reported by participant/applicant/caregiver. Document on Health Information screen in Crossroads (pregnancy-induced health conditions slider). Note: The condition was not present before the pregnancy. 303 (SA/CPA) PG [1] BF [1] NBF [3-6] History of Gestational Diabetes: Any degree of glucose/carbohydrate intolerance with onset or first recognition during a previous pregnancy. Presence of condition diagnosed, documented, or reported by physician or someone working under physician’s orders, or as self-reported by applicant/participant/caregiver. Document on Health Information screen (pregnancy-induced health conditions slider) in Crossroads. 304 (SA/CPA) PG [1] BF [1] NBF [3-6] History of Preeclampsia: Hypertension with onset during pregnancy, usually after 20 weeks gestation, and typically with proteinuria (high levels of protein found in urine). Presence of condition diagnosed, documented, or reported by physician or someone working under physician’s orders, or as self-reported by applicant/participant/caregiver. Document on Health Information screen (pregnancy-induced health conditions slider) in Crossroads. 311 (SA) PG [1] BF [1] NBF [3-6] History of Preterm or Early Term Delivery: Pregnant Woman: Any history of preterm delivery. BF/Non-BF Woman: Most recent pregnancy. Preterm Delivery: Delivery of an infant born < 36 weeks. Early Term Delivery: Delivery of an infant born > 37 and < 38 weeks. Self-reported documented on Health Information screen in Crossroads (pregnancy history tab).