For Medical Providers


ATTENTION: COVID-19 Announcement

The Connecticut WIC State Agency and Local WIC Agencies are operating under strict guidelines due to COVID-19 with no face to face appointments. 

The Connecticut WIC Program remains OPEN for phone appointments ONLY. 

Due to the COVID-19 pandemic we currently do not have access to our DPH fax machine. 

Please forward any certification/medical referral or medical documentation/prescription forms to or view the local agency list for details on site specific contact information.

WIC Local Agency contacts for Providers during COVID 4-7-2020

Thank you for your understanding.


Please click the links below for relevant documents.

        WIC 400-11 Medical Documentation Form - Infants and Children Fillable 3-2021

        WIC 400-11 Medical Documentation Form - Women Fillable 3-2021

  WIC 200-13 Cert Med Ref Forms Infant-Child w-Guidelines (fillable form)

WIC 200-13 Cert Med Ref Forms Women w-Guidelines (fillable form)



Partnering with the WIC Program for Positive Health Outcomes

Partnerships with Medical Providers are critical to the success of the WIC Program.  The Special Supplemental Nutrition Program for Women, Infants, and Children is a nutrition assistance program created to safeguard the health of low-income women, infants, and children up to age five. WIC Participants must have a nutritional risk to be eligible.  Professional WIC staff conduct a nutritional assessment and provide relevant nutrition and health education, referrals to health care and social service program and prescribe checks for nutritious foods to supplement participant diets.  

We hope this Medical Providers page helps you better understand the Connecticut WIC Program and will improve coordination of your patients’ care with our professional nutrition staff at the local WIC agency. 


A series of WIC Fast Facts Flyers for Health Care Professionals about the program were developed to answer common questions health care providers may have about WIC: 

WIC Fast Facts: Referring Women to WIC in the 1st Trimester

WIC Fast Facts: WIC and Health Care Providers Working Together to Support Breastfeeding, Because Breastfeeding Supports Health

WIC Fast Facts: Help Your Patients Stick With WIC until Age 5

WIC Fast Facts: WIC's Efforts in Preventing Childhood Overweight and Obesity

Why do I need to complete a WIC Certification Form?

One way in which WIC safeguards the health of its participants is to ensure WIC participants receive ongoing health care.  When you, as the health care provider complete the WIC Certification Form, key information is provided to the WIC nutrition professional about the overall, health and medical history of your patient.  This information assists the WIC nutritionist in conducting a nutrition assessment, providing relevant education and determining an appropriate food package.  Both the Referring Women to WIC in the 1st Trimester and Help Your Patients Stick with WIC until Age 5 Fast Facts flyers provides more detail on WIC eligibility requirements.

Below are links to the WIC Certification Forms and guidance on how to complete the forms correctly.  

Certification and Medical Referral Form Women

Certification and Medical Referral Form Infants & Children

Breastfed Babies are Welcome Here 

As recommended by the American Academy of Pediatrics (AAP) Policy Statement Breastfeeding and the Use of Human Milk, the Connecticut WIC Program promotes breastfeeding as the normal and optimal method to feed infants for at least the first year of life with a special emphasis on the health benefits derived from exclusive breastfeeding for the first six months.

WIC does its part to promote breastfeeding and support breastfeeding mothers and babies by providing:

  • Competency based breastfeeding training for its staff of nutrition professionals 
  • Individualized prenatal breastfeeding education, with emphasis on exclusive breastfeeding
  • Individualized postpartum support for common lactation issues i.e. strategies for comfortable latch, assessment of sufficient infant intake and output, plan for return to work i.e. use of breast pump.
  • Referrals for clinical lactation problems to health care provider, International Board Certified Lactation Consultant associated with a pediatric practice and/or hospital breastfeeding support groups.

What brand of infant formula does WIC Provide?


In order to contain program costs, the WIC Program is required to bid for standard infant formula. 

Effective October 1, 2016, the Connecticut WIC Program provides Abbott Laboratories® Similac® Advance® or Similac® Isomil® Soy for healthy infants from birth to twelve months of age; whose mothers choose not to breastfeed or partially breastfeed or for whom breastfeeding is medically contraindicated.  Similac® Advance® and Similac® Isomil® Soy both provide 20 kcal/fl oz. at standard dilution. 

Also, WIC provides alternative Abbott Laboratories® standard formulas including Similac Sensitive®, Similac Total Comfort® and Similac for Spit-Up®.  All three of these formulas provide 19 kcal/ fl. Oz at standard dilution and therefore require medical documentation from the health care provider. 

For those participants with an appropriate and documented nutrition related ICD-10 code medical diagnosis, WIC provides special/exempt formulas, such as hypoallergenic, hyper caloric, elemental, and metabolic formulas.

For more information on WIC’s current infant formula contract effective October 1, 2016, click the following links:

July 2016 Health Care Provider Letter

Contract Formula Changes Questions and Answers July 2016

Although small differences in protein, fat, and carbohydrate exist among all standard formulas, there are no medically proven advantages of any particular brand name formula over another. While parents/guardians or health care providers may have a personal preference for a particular brand of formula, funding constraints and WIC regulations limit the issuance of non-contract, special/exempt formulas only to participants with qualifying or serious medical conditions.

Infants or Women with Medical Conditions that Require Special or Exempt Formula

WIC provides special/exempt formulas, such as hypoallergenic hypercaloric, elemental, and metabolic infant formulas with an appropriate nutrition related ICD code medical diagnosis.  Please review WIC 400-11 Special Formula Guidelines for Clinicians 3-2021 to provide further assistance to coordinate the care for your patients.


For a listing of special/exempt formulas provided in Connecticut, please review the WIC Approved Special Formula List.  For additional information regarding Connecticut formulas, please see the Formula Resources webpage.

If your patient requires a special/exempt formula:

Complete a WIC Medical Documentation Form including an ICD code to authorize the use of the product.  WIC professional staff is required to contact the prescribing physician if there are questions or more clarification is needed.

Please be aware that some formulas may need to be "special ordered" through a retail store so as much lead time as possible (at least a week, preferably two weeks) is requested.