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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 10

•Rickets •Beriberi •Hypocalcemia •Osteomalacia •Pellagra •Vitamin K Deficiency •Protein Energy Malnutrition •Menkes Disease •Xerophthalmia •Iron Deficiency Crossroads. Document nutrient deficiency or disease on Care Plan Summary – Nutrition Assessment in Crossroads. 342 (SA/CPA) PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Gastrointestinal Disorders: Disease(s) and/or condition(s) that interfere with the intake or absorption of nutrients. The conditions include, but are not limited to: •Gastroesophageal reflux (GERD) •Peptic ulcer •Post-bariatric surgery •Short bowel syndrome •Inflammatory bowel disease, including Ulcerative colitis or Crohn’s disease •Liver disease •Pancreatitis •Biliary tract disease NOTE: May be considered High Risk at CPA discretion. Presence of gastrointestinal disorder(s) 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 Crossroads. Document GI disorder on Care Plan Summary – Nutrition Assessment in Crossroads. 343 (SA/CPA)

PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Diabetes Mellitus: Consists of a group of metabolic diseases characterized by inappropriate hyperglycemia resulting from defects in insulin secretion, insulin action or both.

NOTE: May be considered High Risk at CPA discretion. Presence of diabetes mellitus diagnosed, documented, or reported by a 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 Crossroads. 344 (SA/CPA)

PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Thyroid Disorders: Thyroid dysfunctions that occur in pregnant and postpartum women, during fetal development, and in childhood are caused by the abnormal secretion of thyroid hormones. Conditions include, but are not limited to: •Hyperthyroidism •Hypothyroidism •Congenital Hyperthyroidism Presence of condition diagnosed, documented, or reported by physician or someone working under physicians’ orders, or as self-reported by applicant/participant/caregiver. Document on Health Information screen (health conditions slider) in Crossroads. Document condition on Care Plan Summary – Nutrition Assessment in Crossroads.