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)

WIC Eligibility

Who is eligible for WIC? More families than you might think. WIC serves Alabama residents who are:

• Pregnant;
• 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.