TEXAS WIC FORMULARY AND MEDICAL REASONS FOR ISSUANCE February 2020 Formula Category Description Qualifying Conditions Staff Instructions - May issue for 1 cert Manufacturer Name period unless otherwise indicated Alfamino ...
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...Texas wic formulary and medical reasons for issuance february formula category description qualifying conditions staff instructions may issue cert manufacturer name period unless otherwise indicated alfamino infant elemental cal oz when mixed scoop to malabsorption syndrome history required nestle water hypoallergenic amino acid gi impairment requested food allergy a failed trial of protein based fat is mct ger gerd hydrolysate extensive ha nutramigen alimentum or oil similar elecare dha ara allergies cow s milk soy pregestimil recommended before issuing medically neocate puramino intact fpies contraindicated available in pwd condition requiring an such as short bowel necrotizing enterocolitis eosinophilic esophagitis etc junior can only be issued women children jr casein abbott lactose free rtu intolerance powder if the form contains sucrose improves compliance better accommodates infants modified tapioca starch corn derivatives certified wcs approve bcad metabolic isoleucine leucine ...