Medical Form

Examine away.

Calling all physicians – we rely on you to provide us with information for WIC particpants to receive special foods to meet their nutritional needs.

WIC Registered Dietitians will review and utilize the medical documentation form to tailor food packages based on your recommendations.

Downloads

SD DOH Medical Documentation Form valid through January 29, 2021.  VIEW

SD DOH Medical Documentation Form valid starting February 1, 2021. VIEW