DOH Form 961-136 Washington Wic Medical Documentation Form - Children 1 - 5 Years - Washington

What Is DOH Form 961-136?

This is a legal form that was released by the Washington State Department of Health - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DOH Form 961-136?
A: DOH Form 961-136 is the Washington WIC Medical Documentation Form specifically designed for children aged 1 - 5 years.

Q: What is WIC?
A: WIC stands for Special Supplemental Nutrition Program for Women, Infants, and Children. It is a federal assistance program that provides nutrition education, healthy food, and support to low-income pregnant women, new mothers, and young children.

Q: Who is this form for?
A: This form is for children aged 1 - 5 years who are enrolled in the Washington WIC program.

Q: What is the purpose of the form?
A: The purpose of DOH Form 961-136 is to document the medical information of WIC participants aged 1 - 5 years in order to determine their eligibility for the program.

Q: Do I need to fill out this form?
A: If your child is enrolled in the Washington WIC program and falls into the age group of 1 - 5 years, then you may be required to fill out this form to provide medical documentation.

Q: What information is needed on the form?
A: The form requires medical information such as the child's height, weight, blood iron level, dietary restrictions, and any medical conditions that may affect their nutritional needs.

Q: Is this form confidential?
A: Yes, the medical information provided on DOH Form 961-136 is treated as confidential and is protected under privacy regulations.

Q: What if I need assistance in filling out this form?
A: If you need help or have questions about filling out DOH Form 961-136, you can reach out to your local WIC office for assistance.