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WIC Nutrition - Food Formula

Food Packages

Texas WIC Food Package Guide – Effective October 1, 2011 – Print Version (418 kb, PDF)
Texas WIC Food Package Guide – Effective October 1, 2011 – Accessible Version (364 kb, PDF)
Food Package Code Quick Reference – Effective October 1, 2011 (281 kb, PDF)

Formula

Texas WIC Formulary and Medical Reasons For Issuance – October 2012 (452 kb, PDF)
Texas WIC Formulary and Medical Reasons For Issuance – October 2012 – Accessible (1 mb, PDF)
Instructions for Concentrating Formula
Texas WIC Medical Request for Formula/Food (Effective 6/2012) (100 kb, PDF)
Texas WIC Program Authorization to Release Medical Information (59 kb, PDF)
Formula Code List – May 2013 (49 kb, PDF)
Texas WIC Formula Maximum Quantity Table – May 2013 (384 kb, PDF)
Formulary October 2012 Addendum – October 2012 (24 kb, PDF)
Quick Reference Table For Formula Approval Levels (10/2012) (37 kb, PDF)
Staff Communication Form (10/2009) (81 kb, PDF)
Documentation of Formula Approval (7/2010) (23 kb, PDF)

Information About Metabolic and PKU Formula

Texas WIC Medical Request for Metabolic Formula/Food (197 kb, PDF)
Metabolic Centers (104 kb, PDF)
Guidelines for Issuing PKU Formula (34 kb, PDF)

Formula Logs-October 2012

Returned Contract Formula Log (WIC 52) (398 kb, PDF)
Returned Formula Log F13-06-13968 (388 kb, PDF)
Returned Formula Log Alternative Version EF13-06-13969 (612 kb, PDF)
Sample Returned Formula Log (771 kb, PDF)

Formula Contract Change 2012

Soy Formula Contract Change flyer (577 kb, PDF)
Physician's Letter (720 kb, PDF)
Changing to a New Formula Liquid Concentrate (525 kb, PDF)
Changing to a New Formula Powder (470 kb, PDF)

WIC EBT Drop Ship Order Form Procedures

Drop Ship Procedures — revised March 2012 (30 kb, PDF)
Drop Ship Checklist — revised March 2012 (26 kb, PDF)
Drop Ship Order Form (15 kb, PDF)
Do Not Buy Statement — revised May 2012 (in all languages) (39 kb, PDF)
Drop Ship Training Slides — revised March 2012 (229 kb, PowerPoint)

Last updated May 15, 2013