Health Care Providers
WIC Prescription Forms
- Alabama WIC Infant Formula Prescription (ADPH-WIC-111a)
- Alabama WIC Child/Woman Formula Prescription (ADPH-WIC-111b)
- Alabama WIC Hospital Special Formula Notification (ADPH-WIC-114)(to be used for WIC participants being discharged on a special formula)
Who is eligible for WIC? More families than you might think. WIC serves Alabama residents who are:
- Breastfeeding, for up to one year postpartum;
- Women who are not breastfeeding, for six months postpartum; and
- Children under five years old.
These residents must also meet WIC income guidelines and have a medical or nutritional need. The guideline is 185% of the poverty level set by the federal government and is based on household size. Medical and nutritional needs are determined at the WIC certification appointment. Examples of qualifying needs include:
- Medical conditions that affect food intake or nutrition status;
- Abnormal height or weight measurements;
- Low intake of essential nutrients; or
- Conditions that predispose a person to inadequate nutrition patterns like lead poisoning, teen pregnancy, alcohol or drug abuse.
Page last updated: March 26, 2020