Forms can be submitted by FAX at 225-0047.
In addition, a new request form will also be required when any changes to the food prescription are requested. You can print the forms you will need by clicking on the links below. A new WIC-395 request form is required at each WIC subsequent certification appointment or at the end of the duration indicated, whichever occurs first. If you would like to apply for WIC, please call the Monroe County WIC Program at 753-4942 or apply at the link below:
Pregnant women on WIC have longer healthier pregnancies and fewer premature births. The foods provided through WIC are a good source of essential nutrients that are often missing from the diets of women and young children. WIC has been shown to improve the health of pregnant women, new mothers and their infants and children. For more information on breastfeeding, please click below: Formula is also available for infants who are either partially breastfed or fully formula fed. This form maybe used to refer patients to the WIC Program and to communicate changes in patient health information. Breastfeeding support is available through our WIC Nutritionists and the Peer Counselor Program (753-5640). ITEM-BY-ITEM INSTRUCTIONS: PARTICIPANT’S NAME: Enter name of the participant.
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EXPLANATION AND DEFINITION: This form is completed by the physician or health care professional licensed to write medical prescriptions under State Law. WIC strongly promotes breastfeeding as the best way to feed your baby. WIC is a special supplemental nutrition program that serves income eligible pregnant, postpartum and breastfeeding women, infants, and children up to age 5 who are at nutrition risk. To use when issuing a prescription for WIC approved special formula and WIC approved foods. (WIC) provides nutritious foods, including low-fat or fat-free milk, cheese, eggs, whole grains, peanut butter/beans, vegetables and fruits. To learn more about the WIC Program, please click here. To be eligible, the applicant must be a resident of New York State and have a household income of less than 185% of the poverty level. To apply for WIC or to make an appointment, call 1-855-4-SCDHEC (1-85). To check to see if you may be eligible for WIC benefits, visit the WIC Prescreening Tool. The WIC program helps safeguard the health of income-eligible pregnant and postpartum women, infants.
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Manager, WIC WIC Program is a supplemental food and nutrition education program that serves pregnant, breastfeeding, postpartum women, infants, and children up to the age of five. WIC is a nutrition program that provides health education, healthy foods, breastfeeding support, and other services free of charge to South Carolina families who qualify.