Georgia WIC Program

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Use this form to request special formulas and/or medical foods for patients with qualifying medical conditions. Please refer to Georgia WIC Form #2 (Referral Form & Medical Documentation for Special Food Substitutions) for children/women with food intolerances (e.g., lactose intolerance) or food allergies (e.g., milk protein allergy) that can be managed with food …

  Food, Special, Request, Special request, Special food