Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

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I. Policy:

A hematological test for anemia shall be performed and documented at certification for applicants with no other risk factor present. For applicants with a qualifying risk factor present at certification, a hematological test shall be performed and documented within 90 days of the date of certification.

II. Procedure(s):

A. Infants

1) Infants who are seen for a certification or mid-certification appointment between the ages of 9 and 12 months of age shall have a hematological test preformed. Schedule and perform a hematological test after 9 months of age but before the infant’s first birthday.

2) Schedule the child’s certification at 11 months of age (in the 30 days prior to the child’s first birthday) and perform the infant hematological test at this visit

B. Children

1) Children must have at least 2 hematological tests performed before the age of 2, preferably with 6 months between them a. These tests shall be performed at the 1 year old child certification and mid-certification appointments. 1. If a hematological test was preformed while the child was between 9 and 12 months of age, this value can be used to fulfill the test at certification.

2) Children between 2 and 5 years of age must have a hematological test preformed at each certification appointment a. If the hematological value is low, another hematological test must be performed at the mid-certification appointment.

C. Women

1) Pregnant women shall have a hematological test performed during the current pregnancy

2) Breastfeeding women shall have a hematological test performed during the postpartum period, ideally within 6 weeks after termination of the pregnancy

3) Postpartum women shall have a hematological test performed during the postpartum period

Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

Page 2 of 4

D. Inform the participant, parent / legal guardian or caretaker if there is a finding of low hemoglobin.

1) Document the hematological test results on the Anthro/Lab screen in Crossroads

2) Provide appropriate nutrition education and make any necessary referrals

3) Document provided nutrition education and referrals on the appropriate screens in Crossroads

E. Exceptions to blood work policy

1) If an applicant / participant has a medical condition such as hemophilia, fragile bones, or a serious skin disease, obtain medical data from another source or screen for risks other than anemia.

a. A statement from the physician documenting the medical condition must be scanned in the participant’s record and information added into the Care Plan.

b. If the medical condition is considered treatable, a new statement from the physician is required at subsequent certifications

c. If the medical condition is considered “life-long,” a new statement is not required

2) If an applicant / participant refuses a hematological test due to religious beliefs, screen for risks other than anemia.

a. Document refusal on the Anthro/Lab screen of Crossroads and add information about the refusal into the Care Plan.

3) If obtaining a hematological test from an HIV infected applicant / participant would put the health and safety of local agency personnel at risk, due to circumstances such being hostile and/or physically abusive, refer the applicant / participant to another resource.

a. Document medical condition and referral in participant’s record on the appropriate screen in Crossroads and add information about the incident in the Care Plan.

Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

Page 3 of 4

Infant and Child Hematological Test Schedule

Category Hematological Test Requirement Infant Less than 9 months of age Certification Mid-Certification No hematological test required 9 to 12 months of age Certification Mid-Certification Hematological test required

Use this hematological test for the 1 year old certification requirement Children 1 to 2 Years of Age Certification

Hematological test required at the 1 year old child certification appointment A child, who was not on WIC as an infant and is certified on or after 12 months of age and before 18 months of age, must have two hematological tests by 2 years of age. Mid-Certification Hematological test required at the 1 year old mid- certification appointment (Approximately 18 months of age) Children 2 to 5 Years of Age Certification

A Hematological test is required annually at the certification appointment.

Mid-Certification A hematological test is ONLY required when the results were abnormal at the previous certification or high risk appointment.

Division of Community Nutrition

Subject: Determine Nutritional Risk – Hematological Policy: CRT 06.2 Reference: N / A Effective: June 15, 2018 Supersedes: August 12, 2013

Page 4 of 4

Women’s Hematological Test Schedule

Category Hematological Test Requirement Pregnant Woman Certification Hematological test must be taken during current pregnancy.

Evaluate the test results according to the trimester in which the test was taken. Breastfeeding Woman Certification Hematological test required after delivery. Postpartum Woman Certification Hematological test required after delivery.