Missouri WIC requires this form before it issues exempt infant formula, WIC-eligible nutritionals or modified supplemental foods, or when contract formula must be mixed differently from the label. The provider records the formula, calorie concentration, daily amount, approval length and a qualifying condition tied to a Missouri WIC risk factor. A regular prescription is not an allowable substitute.
A state-licensed prescriptive authority (MD, DO, PA, NP, CNS or CNM) completes sections A to D and signs, and WIC staff complete all of section E. Local agency staff may fill in section C before the provider signs.
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Medical Documentation - Health Care Provider Authorization
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Approval length is 1 to 6 months and ends on the last day of the month. A new WIC-27 must be completed at least every six months, and some products, such as metabolic formulas, have shorter approval periods. WIC records the end date in section E.
Only when foods must be omitted or changed; otherwise full age-appropriate WIC food is issued. Section C asks whether an infant can eat infant foods or needs extra formula, whether a child or woman needs infant foods, and which foods to omit, such as cow's milk, eggs or peanut butter.