Page 405

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 12

349 (SA/CPA)

PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Genetic and Congenital Disorders: Hereditary or congenital condition at birth that causes physical or metabolic abnormality. The current condition must alter nutrition status metabolically, mechanically, or both. May include but not limited to: •Cleft lip or palate •Sickle Cell Anemia (not Sickle Cell Trait) •Thalassemia Major •Down’s Syndrome •Congenital heart disease (CHD) •Tetralogy of fallot •Muscular Dystrophy •Pulmonary atresia •Transposition of great arteries (TGA) •Trachea-esophageal fistula •Esophageal atresia •Gastroschisis •Omphalocele •Diaphragmatic hernia •Intestinal Atresia •Hirschsprung’s disease •Hemophilia NOTE: May be considered High Risk at CPA discretion. Presence of genetic and congenital disorders 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 condition and treatment plan, if applicable, on Care Plan Summary – Nutrition Assessment in Crossroads. 351 (SA/CPA)

PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Inborn Errors of Metabolism: Inherited metabolic disorders caused by a defect in the enzymes or cofactors that metabolize protein, carbohydrate, or fat. Including but not limited to: •Phenylketonuria (PKU) •Maple Syrup Urine Disease (MSUD) •Galactosemia •Glycogen storage disease •Medium-chain acyl-CoA dehydrogenase (MCAD) NOTE: May be considered High Risk at CPA discretion. 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 Crossroads. Document condition and treatment plan, if applicable, on Care Plan Summary – Nutrition Assessment in Crossroads. 352 (SA/CPA)

PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Infectious Diseases: Come from bacteria, viruses, parasites, or fungi and spread directly or indirectly from person to person. 352a Acute Infectious Diseases: Characterized by a single or repeated episode of relatively rapid onset and short duration. Presence of condition diagnosed, documented, or reported by a physician or someone working under physician’s orders as self-reported by applicant/participant/caregiver. Document on Health Information screen (health conditions slider) in