VIII. Certification August 2021 8.007 - 1 8.007 Risk Code Identification CFR § 246.7 (e) and WIC Policy Memorandum May 2011, Transmittal of New and Revised Nutrition Risk Criteria I. Policy Statement DC WIC has adopted the risk criteria developed by the Risk Identification and Selections Collaborative (RISC) Committee for the National WIC Association (NWA) and the Food and Nutrition Service (FNS) divisions of the USDA. DC WIC implements the Nutrition Risk Criteria located on the Local Agencies > Trainings page at www.dcwic.org. Applicants will be assigned all risk codes that apply, according to HANDS and the Nutrition Risk Manual. To ensure participant-centered education, it is highly recommended for staff NOT to tell participants their risk(s) directly; instead, it is preferred for staff to offer nutrition education topics related to the risk(s). II. Staff Responsible for Determining Nutrition Risk LA Staff responsible for determining nutrition risk include: a. Competent Professional Authorities (CPAs) – may determine risk, provide nutrition education, and prescribe supplemental foods for all participants; must counsel participants indicated as high-risk. b. Competent Para-Professional Authorities (CPPAS) – may determine risk, provide nutrition education, and issue supplemental foods to low-risk participants. If a CPPA identifies a participant as high-risk during any part of the health and nutrition assessment, they must refer the participant to the CPA for follow-up.

III. Procedures for Determining Nutrition Risk The Nutrition Risk Manual (NRM), located on www.dcwic.org under Local Agencies > Trainings, is a comprehensive guide to each nutrition risk code. LA staff may refer to this manual online, or may print it for on-site reference if desired. In addition to the NRM, which is over 350 pages, there are “cheat sheets” for LA staff to use with the expectation that staff are familiar with risk code indications. If staff have questions related to risk code descriptions or indications, they should refer to the NRM and to their Local Agency Director, as needed. The CPA shall use the “CPA Risk Codes Cheat Sheet (Appendix 8.007A) for determining nutritional/medical risk for program eligibility. The CPPA shall use the “CPPA Risk Codes” (see Appendix 8.007B) for determining nutritional/medical risks for program eligibility. NOTE: Risk codes are not final in the participant’s record until they clicks “Complete Assessment” in the Nutrition Care Plan screen. Risk codes can be added at any time throughout the certification as they are identified as HANDS will capture the date the risk was added to the record.

VIII. Certification August 2021 8.007 - 2 IV. Self-Reporting or Self- Diagnosis Self-reporting of a diagnosis by a medical professional shall not be confused with self-diagnosis, where a person reports to have or have had a medical condition, without any reference to a professional diagnosis. A self-reported medical diagnosis such as, “My doctor says that I have/my son or daughter has…” shall prompt the CPA to validate the presence of the condition by asking more in-depth questions related to the diagnosis. Self-reporting of “History of” conditions shall be handled in the same manner as self-reporting of current conditions that require a physician’s diagnosis. The applicant may report to the CPA that they were diagnosed by a physician with a given condition in the past. Again, self-diagnosis of a past condition shall not be confused with self-reporting. V. Determining Nutrition Risk The participant’s health and nutrition assessment, including collection of anthropometric and biochemical data, identifies the nutritional needs and interests of the participant. The nutrition assessment provides the basis for the nutrition care plan, including nutrition education/counseling, food package assignment, referrals, and follow-up plans. During the assessment process, heights, weights, biochemical information, dietary information, medical information, and family situation are assessed and any potential risk codes are identified. Individuals applying for enrollment in DC WIC must have at least one risk code to be eligible for participation. Women’s Nutrition Risk Determination: All data used to determine nutritional risk will be reflective of the woman’s categorical status at the time of certification. For example, a woman certified during pregnancy as at risk for anemia cannot be certified in the postpartum period using any hemoglobin or hematocrit value that was obtained during her pregnancy.