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WIC 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.