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Get Texas Wic Medical Request For Formula/food

Maximum allowed may be provided unless a lesser amount is indicated. Requested Length of Issuance: month(s) Requested Length of Issuance: month(s) Formula will be issued up to 12 months of age unless otherwise indicated. * See table 2 on reverse side for formulas no longer available to first time Texas WIC participants. Qualifying Condition/Diagnosis (required; please check all that apply): Cardiovascular condition GI impairment Malabsorption.

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