WIC Medical Documentation Form (MDF)

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Description: Form to be completed by medical provider when medical formulas or certain supplemental foods are being requested. Quantity: Order the total number of forms needed (exa mple: 100, 200, etc.) Item will be shipped in pads of 100 forms. Format: 8.5" x 11" form. Languages available in print: English Form number: 57-636 Revision date: 3/2025 Show more