DC WIC POLICY & PROCEDURE MANUAL

Policy 8.010 1 | P a g e Title: Anthropometric and Biochemical Data Collection Category: Certification CFR Reference: 7 CFR 246.7 Policy Number 8.010 Effective Date: December 1st 2021 Revised Date: April 30th 2024

POLICY STATEMENT: Anthropometric and Biochemical Collection Height, weight, and hemoglobin measurements must be performed and/or documented in the applicant’s record at the time of certification in accordance with 7 CFR 246.7(e)(1)(i)(A). Additional anthropometric and hemoglobin screening may be required depending on the participant’s category, certification length and/or nutritional risk. See Procedures section below for assessment frequency. Data submitted by a healthcare provider may be used to establish nutritional risk but must have been taken within the last 60 days for anthropometric data or last 90 days for blood work data. Hemoglobin screening may be deferred at the time of certification only if another qualifying nutritional risk is identified (see DC WIC Nutritional Risk Manual) and the participant or Authorized Representative (AR) agrees to submit the results of an outside blood test performed within 90 days of the certification. For women participants, the anthropometric and hemoglobin measurements must be reflective of her status (i.e., pregnant women must have their data taken during pregnancy; postpartum women must have data taken following the termination of pregnancy). Acceptable forms of anthropometric and biochemical documentation include: • Medical provider’s prescription form • Medical provider’s letterhead with measurements • DC WIC Medical Prescription Form • Medical records that include the date of measurements and the provider’s name • Verbal measurements from a medical provider The Local Agency staff must include the name of the provider organization in which the anthropometric and/or biochemical data was obtained in the “I” portion of the TGIF note. Blood Lead Screening and Referral Local Agency staff are to screen for blood lead testing for all participants at the time of certification. If the blood lead value is known, this value is to be documented in the participant’s record as part of the TGIF note. If the blood lead value is unknown or if a blood lead test has not yet been performed for a child participant, then a referral to the participant’s healthcare provider must be made in accordance with DC WIC policy 8.018 Referrals Overview.

Risk code 211 Elevated Blood Lead should be assigned if the blood lead value is higher than established cut-offs (see DC WIC Nutrition Risk Manual for more details).

DC WIC POLICY & PROCEDURE MANUAL

Policy 8.010 2 | P a g e Clinic Laboratory Improvement Amendments (CLIA) Certificate A current CLIA certificate must be posted in each WIC clinic where hemoglobin assessments are performed. For WIC clinics with more than one lab, only one CLIA certificate needs to be posted. WIC clinic sites must have one of two types of CLIA certificates posted in laboratory space where hemoglobin screening is performed. The Local Agency should obtain a copy of the certificate from DC Health or the Local Agency’s lab director. Visit https://www.cms.gov/regulations-and-guidance/legislation/clia?redirect=/clia/ for more information on CLIA certificates and waivers. PROCEDURE Medical Consent Before taking anthropometric measurements and/or conducting a hemoglobin screening, the Local Agency staff member must inform the participant or AR the reason for performing these actions and obtain consent. The Local Agency staff member will collect the participant or AR’s signature under “Consent” on the Medical Screen in HANDS. If a participant or AR does not consent to the anthropometric collection or hemoglobin screening, then the Local Agency staff must request that these measurements be provided in accordance with this policy, or the participant may risk a delay in receiving WIC services. Anthropometric Collection Refer to the DC WIC Anthropometrics Manual for performing and collecting anthropometric measurements. All infant, children, and breastfeeding women must have height and weight measurements collected at certification and mid-certification appointments (approximately six months from the certification date) unless one of the exception criteria is met in DC WIC policy 8.003 Physical Presence. Biochemical Data Collection Refer to the DC WIC Lab Procedure Manual for performing hemoglobin testing for DC WIC participants. Frequency of Assessment Additional anthropometric and hemoglobin assessments are required at minimum based on the category and age of participant below (next page):

Biochemical Data Collection Chart Category Infant’s age at time of certification Frequency of hemoglobin testing Exceptions to Certification Blood Work Required

For all categories – at least one qualifying nutritional risk is present at certification and blood test result is obtained within 90 days of certification. Pregnant Women N/A One blood test per certification

DC WIC POLICY & PROCEDURE MANUAL

Policy 8.010 3 | P a g e Postpartum Women 0-6 months *One blood test per certification, ideally between 4 to 6 weeks after end of pregnancy Breastfeeding Women 0 - 5 months One blood test per certification, ideally between 4 to 6 weeks after end of pregnancy

6 – 12 months No blood test required if a test was taken after end of pregnancy (documentation needed) Staff may accept a blood test result more than 60 days old (7 CFR 246.7(e)(1)(ii)(B)(3)). Infants 0-5 months Not required

6-8 months Not required at time of certification. The blood test may be performed after the infant is at least 9 months of age 9-11 months One blood test per certification

Children 12-24 months N/A Two blood tests needed by 24 months of age

If an infant blood test was performed, then only one additional blood test needed per certification

Children 24-60 months N/A At least one blood test per certification

Women less than 4 weeks postpartum Local Agency staff must use the pending lab code “LESS THAN 4 WEEKS POSTPARTUM” for women less than four weeks postpartum as HANDS does not allow a hemoglobin value to be entered at this time. The Local Agency may choose to perform the following: • Request the participant return between four to six weeks postpartum to have a hemoglobin test performed. • Request the participant submit hemoglobin test results obtained within 90 days of certification. • Perform the hemoglobin test at the time of certification and document this value in the participant’s TGIF note. Once the participant is more than four weeks postpartum, the Local Agency staff may enter this value into the participant’s Medical screen in HANDS using the date the test was initially performed.

DC WIC POLICY & PROCEDURE MANUAL

Policy 8.010 4 | P a g e Low Hemoglobin Readings If the hemoglobin reading is below 10.0 g/dL, the Local Agency staff must perform a subsequent hemoglobin test. The subsequent test must be performed at a different site, preferably with a finger on the other hand. The higher of the two hemoglobin values is entered into HANDS and should be used for referral purposes.

Frequency of Testing for Low Hemoglobin Results A hemoglobin reading at or below 7.0 g/dL requires an immediate referral to the CPA and for medical attention. The CPA must ensure appropriate nutrition education and referrals are provided to address the low hemoglobin reading and conduct a high-risk follow-up appointment for retesting of the hemoglobin value in accordance with 2.008 Serving High Risk Participants. Exemptions from Hemoglobin Testing Hemoglobin testing may be waived for a participant that has one of following: • Religious objection • Medical condition such as hemophilia, thalassemia, or sickle cell anemia • If performing the test will cause physical harm to the participant or staff member If a participant meets the exemption criteria, the CPA/CPPA must document this in the participant’s TGIF note in accordance with DC WIC policy 2.005 Nutrition Education Overview. Blood Work Data Not Received in 90 Days If a participant is not able to provide the required hematological data within 90 days of certification, the Local Agency must require the participant to come to the clinic to obtain this data unless the participant falls under the existing exemptions in DC WIC policy 8.003 Physical Presence and Identification.

The participant will not be terminated for failure to provide the hematological data within 90-day time frame, provided that the CPA/CPPA has identified a nutrition risk for eligibility, in accordance with FNS WIC Policy Memo 2001-2 WIC Bloodwork Requirements and DC WIC policy 8.001 Certification Overview. REFERENCES 7 CFR 246.7(e)(1)(i)(A) DC WIC policy 2.005 Nutrition Education Overview, 2.008 Serving High Risk Participants, 8.003 Physical Presence and Identification, 8.018 Referrals Overview ATTACHMENTS & FORMS Policy Memo 2001-2 WIC Bloodwork Requirements (Attachment D) DC WIC Nutrition Risk Manual DC WIC Anthropometric Manual DC WIC Laboratory Manual