Patient Enrollment Information

To enroll, an individual must be:

• In a household with an income level of 185% of poverty or less, or enrolled in Medicaid
• A pregnant, breastfeeding, or post-partum woman; or infant, or child under the age of five
• Identified as being at nutritional risk by a WIC-certified health care professional; and
• A new York State Resident

In order for the patient to be certified for WIC, the local WIC agency needs the following information:

• Length/height and weight
• Hemoglobin or hematocrit levels
• Prenatal history
• Expected date of delivery
• Medical or nutritional risk factors

If you have this information, send it with your medical referral form. If an infant requires one of the special formulas available through WIC, a physician's prescription is needed before the formula will be provided.