Division of Community Nutrition

Subject: Food Prescription III – Special Needs Policy: FDS 02.2.2 Reference: CFR §246.10 Effective: October 1, 2014 Supersedes: August 12, 2013

Page 1 of 1 Policy:

All Special Needs participants shall be prescribed a food prescription that is based on age, meets the participant’s nutritional needs, cultural preferences and household conditions.

I. Procedure(s):

A. Special Needs Food Prescription

1. Provide a special needs food prescription when prescribing: a) special exempt formula b) medical foods c) whole milk for participants over the age of 2

2. In addition to formula, medical foods, or whole milk, individuals receiving a special needs food prescription shall receive supplemental foods when prescribed by the medical provider. Supplemental foods will be issued in the amounts indicated by their participant category (infant, child, pregnant, postpartum, partial / fully breastfeeding) unless prohibited by medical provider.

3. When the Special Needs Food Prescription is issued, medical documentation written by a licensed healthcare professional authorized to write medical prescriptions is required.

4. The WIC 395 form shall be used as medical documentation. Refer to FDS 03.2 for the WIC 395 instructions.

B. Reasons To Prescribe Whole Milk

1. Failure To Thrive

2. Underweight a. Child: < 5th percentile wt/ht b. Women: BMI< 18

3. Poor maternal weight gain

4. Metabolic or disease states requiring increased calories