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Colorado WIC Physician Authorization Form (PAF)

Colorado WIC uses this two-page authorization to issue special formulas, medical foods and modified food packages. It is also needed for standard contract formula after 12 months and for extra formula for infants 6 to 11 months who can't tolerate solids. WIC dietitians or nurses approve it under program policy and set the expiration date.

Who completes it

The medical provider enters the patient's measurements if known, the food section, the formula choice and Sections A, B and C (qualifying condition, quantity, duration), then signs with name and credential. WIC staff record the approval and the prescription expiration date.

Submitting and payment

How to submit it
Return the form to the patient's local WIC clinic by fax, email or paper copy. The top of the form has space for the clinic name and an attention line.

Good to know

  • No prescription is needed for infants up to 12 months on the standard contract formulas: Enfamil Infant, ProSobee, Gentlease, Reguline and AR, per the June 2026 form.
  • More than one formula can be checked; the WIC dietitian or nurse picks one based on availability and family preference. Metabolic formulas are written in from the state's allowable list.
  • Whole or 2% milk for women and children 2 and older is available only with a special formula or supplement for a medical condition. Soy milk or tofu can be substituted.
  • Similac Hydrolyzed Protein HMF goes to Medicaid first, needs a new form every month, is capped at 20 packets a day and stops once the infant exceeds 3.6 kg.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician's Authorization Form (PAF)

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Does a Colorado infant on Enfamil need the PAF?

Not for standard contract formula. The form states no prescription is needed for infants up to 12 months on Enfamil Infant, ProSobee, Gentlease, Reguline or AR. A PAF is needed for other formulas, for standard formula after 12 months, and for extra formula when an infant 6 to 11 months old can't tolerate solids.

What does Section I of the Colorado PAF cover?

Section I, WIC Supplemental Foods, is completed only if a modified food package is needed for a medical condition. The provider can request no restrictions, omit specific foods for infants or for children and women, substitute whole or 2% milk, or substitute soy milk or tofu. Otherwise WIC dietitians or nurses decide the foods.