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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 16

363 (SA/CPA) BF [1] NBF [3-6] Pre-Diabetes: Impaired fasting glucose (IF) and/or impaired glucose intolerance (IGT); conditions characterized by hyperglycemia that does not meet the diagnostic criteria for diabetes mellitus. 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 the Health Information screen (health conditions slider) in Crossroads. 371 (SA) PG [1] BF [1] NBF [3-7] Nicotine and Tobacco Use: Any use of products that contain nicotine and/or tobacco to include, but not limited to, cigarettes, pipes, cigars, electronic nicotine delivery systems (e-cigarettes, vaping devices), hookahs, smokeless tobacco (chewing tobacco, snuff, dissolvable), or nicotine replacement therapies (gums, patches). Self-reported smoking habits documented on Health Information screen in Crossroads. 372* (SA/CPA) (HR) PG [1] BF [1] NBF [3-6] Alcohol and Substance Use: Pregnant Woman: •Any alcohol use. •Any illegal substance use and/or abuse of prescription medications. •Any marijuana use in any form. BF/Non-BF Woman: •Alcohol use: High Risk Drinking (Routine consumption of >8 drinks per week or > 4 drinks on any day; or Binge Drinking (Routine consumption of > 4 drinks within 2 hours. •Any illegal substance use and/or abuse of prescription medications. •Any marijuana use in any form (breastfeeding women only). Self-reported alcohol and/or illegal substance use documented on Health Information and Dietary Health screens in Crossroads. Document referral, as appropriate. See WIC Procedure Manual, Nutrition Education Chapter. 381 (SA/CPA) PG [1] BF [1] NBF [3-6] Infants [1] Child [3] Oral Health Conditions: Conditions including, but not limited to: •Dental Caries (tooth decay or cavities) •Periodontal diseases, including gingivitis and periodontitis •Tooth loss and/or ineffectively replaced teeth, or oral infection which impair the ability to ingest food in adequate quantity or quality. Presence of oral health conditions diagnosed, documented, or reported by a physician, dentist 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 condition and impact on nutrition status on Care Plan Summary - Nutrition Assessment in Crossroads. 382* (SA/CPA) (HR) PG [1] BF [1] NBF [3-6] Fetal Alcohol Spectrum Disorders: Group of conditions that can occur in a person whose mother consumed alcohol during pregnancy. Presence of conditions diagnosed, documented, or reported by physician or someone working under