New Mexico WIC needs this request on file before a family receives any medically requested formula or food, including exempt or medical formulas and changes that add or remove regular WIC foods. The back of the form lists every exempt or medical formula NM WIC provides. Some products are bought at WIC-approved stores, while others are ordered from a third-party vendor and delivered to the WIC clinic.
A provider legally authorized to prescribe in New Mexico completes it: an MD, DO, nurse practitioner, certified nurse-midwife, physician assistant supervised by a physician, or registered dietitian.
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New Mexico WIC Medical Request for Formula and/or Food
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Yes. NM WIC may accept a prescription that includes the prescription date, the participant's name and date of birth, the qualifying medical condition, the formula or nutritional supplement, and the provider's signature and contact information. The amount per day and length of time are helpful but not required.
Up to 6 months. NM WIC lists the length of time required among the prescription details and sets a maximum of 6 months, so a patient who needs a medical formula for longer will need a new request from the provider.
Yes. New Mexico WIC accepts prescriptions from providers legally authorized to prescribe in the state, and its list includes registered dietitians alongside MDs, DOs, nurse practitioners, certified nurse-midwives and physician assistants supervised by a physician.