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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 15

Infants [1] Child [3] must be severe enough to affect nutritional status. Includes, but is not limited to: •Juvenile Idiopathic Arthritis (JIA). •Cardiovascular Disease •Systemic Lupus Erythematosus (SLE) •Polycystic Ovary Syndrome (PCOS) •Persistent Asthma (moderate or severe) requiring daily medication •Cystic Fibrosis NOTE: May be considered High Risk at CPA discretion. working under a physician’s orders, or as self- reported by applicant/participant/caregiver. Document on Health Information screen (health conditions slider) in Crossroads. Document impact on nutritional status on participant’s Care Plan Summary - Nutrition Assessment in Crossroads. 361 (SA/CPA) PG [1] BF [1] NBF [3-6] Child [3] Mental Illness: A syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental illnesses where the current condition, or treatment for the condition may affect nutrition status include, but are not limited to: •Depression •Anxiety Disorders •Post-Traumatic Stress Disorder (PTSD) •Personality Disorders •Schizophrenia •Obsessive-Compulsive Disorder (OCD) •Bipolar Disorders •Attention-Deficit/Hyperactivity Disorder (ADHD) Presence of a mental illness that is diagnosed, documented, or reported by physician or someone working under physician’s orders, or as self-reported by applicant/participant/caregiver. Must be documented on Health Information screen (health conditions slider) in Crossroads. Document condition and impact on nutritional status on participant’s Care Plan Summary - Nutrition Assessment in Crossroads. 362 (SA/CPA) PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Developmental, Sensory or Motor Disabilities Interfering with the Ability to Eat: Disabilities that restrict the ability to intake, chew, or swallow food or require tube feeding to meet nutritional needs. Disabilities include, but not limited to: •Minimal brain function/head trauma •Feeding problems due to developmental disability, such as pervasive development disorders (PPD) which include autism •Birth injury •Brain damage •Other disabilities NOTE: May be considered High Risk at CPA discretion. Presence of condition(s) 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 (health conditions slider) in Crossroads. Document disability and impact on nutritional status on participant’s Care Plan Summary - Nutrition Assessment in Crossroads.