Page 417

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 24

Examples of dietary supplements which when ingested in excess of recommended dosages, may be toxic or have harmful consequences: • Single or multiple vitamins. • Mineral supplements. • Herbal or botanical supplements/remedies/teas. 427.2

Consuming a diet very low in calories and/or essential nutrients; or impaired caloric intake or absorption of essential nutrients following bariatric surgery: • Strict vegan diet. • Low-carbohydrate, high-protein diet. • Macrobiotic diet. • Any other diet restricting calories and/or essential nutrients

427.3

Compulsively ingesting non-food items (pica): Examples include • Chalk • Ashes • Baking soda • Burnt matches • Carpet fibers • Cigarette • Clay • Dust • Large quantities of ice and/or freezer frost • Paint chips • Soil • Starch (laundry and cornstarch)

427.4

Inadequate vitamin/mineral supplementation recognized as essential by national public health policy: • Consumption of less than 27 mg of iron as a supplement daily by pregnant woman. • Consumption of less than 150 μg of supplemental iodine per day by pregnant and breastfeeding women. • Consumption of less than 400 mcg of folic acid from fortified foods and/or supplements daily by non-pregnant woman.

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Page 417

Official source

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 24

Examples of dietary supplements which when ingested in excess of recommended dosages, may be toxic or have harmful consequences: • Single or multiple vitamins. • Mineral supplements. • Herbal or botanical supplements/remedies/teas. 427.2

Consuming a diet very low in calories and/or essential nutrients; or impaired caloric intake or absorption of essential nutrients following bariatric surgery: • Strict vegan diet. • Low-carbohydrate, high-protein diet. • Macrobiotic diet. • Any other diet restricting calories and/or essential nutrients

427.3

Compulsively ingesting non-food items (pica): Examples include • Chalk • Ashes • Baking soda • Burnt matches • Carpet fibers • Cigarette • Clay • Dust • Large quantities of ice and/or freezer frost • Paint chips • Soil • Starch (laundry and cornstarch)

427.4

Inadequate vitamin/mineral supplementation recognized as essential by national public health policy: • Consumption of less than 27 mg of iron as a supplement daily by pregnant woman. • Consumption of less than 150 μg of supplemental iodine per day by pregnant and breastfeeding women. • Consumption of less than 400 mcg of folic acid from fortified foods and/or supplements daily by non-pregnant woman.