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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 9

34 or more 4 or less 335 (SA) PG [1] BF [1] NBF [3-6] Multi-fetal Gestation: More than 1 fetus in a pregnancy. Pregnant Woman: Current pregnancy BF/Non-BF Woman: Most recent pregnancy Presence of condition diagnosed and reported by physician or someone working under physician’s orders. Document on Health Information Screen in Crossroads. When documented here, it changes the food prescription. Note: The Family Size on the Income Information screen should reflect Multi-fetal Gestation. 336 (CPA) PG [1] Fetal Growth Restriction: Formerly Intrauterine Growth Retardation (IUGR); fetal weight <10th percentile for gestational age. Presence of condition diagnosed, documented, or reported by physician or someone working under physician’s orders, or as self-reported by applicant/participant/caregiver. Manually assign using Assigned Risk Factors screen in Crossroads. 337 (SA/CPA) PG [1] BF [1] NBF [3-6] History of Birth of a Large for Gestational Age Infant: Birth of an infant weighing > 9 lbs. (4000 gm). Pregnant Woman: Any history BF/Non-BF Woman: Most recent pregnancy or any history Self-reported birth weight of the infant documented on Health Information screen (pregnancy history tab) in Crossroads. 338 (SA) PG [1] Pregnant Woman Currently Breastfeeding: Breastfeeding woman now pregnant. Review/evaluate mother’s medical history and diet, along with breastfeeding goals or self- reported by applicant/participant. The risk will assign when currently breastfeeding box is checked on the pregnant woman Health Information screen in Crossroads. 339 (SA/CPA) PG [1] BF [1] NBF [3-6] History of Birth with Nutrition Related Congenital or Birth Defect: Woman who has given birth to an infant who has a congenital or birth defect linked to inappropriate nutritional intake, e.g., inadequate zinc, folic acid, or excessive vitamin A. Pregnant Woman: Any history BF/Non-BF Woman: Most recent pregnancy Presence of condition diagnosed, documented, or reported by physician or someone working under physician’s orders or self-reported by applicant/participant/caregiver. Document on Health Information screen (health conditions slider) in Crossroads. Document defect and what caused it on Care Plan Summary – Nutrition Assessment in Crossroads. 341* (SA/CPA) (HR) PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Nutrient Deficiency or Disease: Any currently treated or untreated nutrient deficiency or disease. These include, but are not limited to, •Scurvy •Cheilosis 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 (health conditions slider) in