Texas community resource
Therapeutic Formula Medical Request Process
Texas WIC
Texas WIC reviews medical requests for therapeutic or metabolic formula for eligible participants.
How to get help
Ask the treating health-care provider to complete the appropriate Medical Request for Formula form. The provider may fax it to the patient's local WIC clinic or give it to the patient to bring to the clinic. Call the local clinic with questions or call 800-942-3678 for Texas WIC information.
Who this service helps
Texas WIC participants with a documented qualifying medical need. All medical formula requests are subject to local clinical review and approval under WIC policy and federal regulations.
Where this service is available
Service area: Texas WIC participants statewide through their local WIC clinics, including participants in all assigned East Texas counties.
A service area describes where help is offered or who may be served. It is not necessarily the organization’s physical location.
Location and contact
Source and verification
Source: Public-source listing
Cost / fees
WIC is a supplemental nutrition program; approved formula type and amount depend on program policy, medical review, and the participant's food package.
About this service
A health-care provider completes the applicable Texas WIC medical-request form and sends it to the patient's local WIC clinic. Local clinical staff review each request under state policy and federal regulations.
Other resources that may help
Before you contact this provider
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