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    • One Health
    • Publications
  • How Do I?
    • Apply For
      • Birth/Death Certificate
      • Employment
      • Food Worker Card
      • Nurse-Family Partnership
      • WIC Benefits
    • Contact
      • Board of Health
      • Health District Departments
    • Dispose Of
      • Medicine
      • Paint
      • Syringes
      • Tires
    • Lookup
      • Fee Schedule
      • Rules & Regulations
    • Pay My
      • Bill
    • Report
      • Notification, Comment, or Compliment
    • Request
      • Immunization Records
      • Internship
      • Public Record
      • Purchase Surplus Materials
      • Sewage System Inspection
    • Stay Connected
      • Health District News
      • Social Media
    • View
      • Board of Health Agenda & Minutes
  • Health Topics
    • Diseases & Conditions
      • Avian Flu ("Bird Flu")
      • Campylobacteriosis
      • Chickenpox
      • Chronic Conditions
      • COVID-19
      • Cryptosporidium
      • Cyclosporiasis
      • E. coli
      • Giardia
      • Hand, Foot & Mouth
      • Listeria
      • Measles (Rubeola)
      • Monkeypox
      • Rabies
      • RSV
      • Salmonella
      • Syphilis
      • Tuberculosis (TB)
      • Vibriosis
      • West Nile Virus
      • Yersiniosis
    • Health & Development
      • Behavioral Health
      • Breastfeeding
      • Building Resilience
      • Developmental Screening
      • Healthy Aging
      • Healthy Eating & Active Living
      • Healthy Pregnancies
      • Healthy Teens
      • Immunizations
      • Infection Control (Handwashing)
      • Marijuana & Health
      • Tobacco
    • Health Equity
      • Social Determinants of Health
    • Healthy Environments
      • Air Quality
      • Bats
      • Drinking Water
      • Water Recreation
    • Safety
      • Child Passenger Safety
      • Drowning Prevention
      • Head Injury Prevention
      • Falls Prevention
      • Firearm Safety
      • Suicide Prevention
      • Opioids & Other Drugs
    • One Health
  • Programs & Services
    • Animals & Insects
      • Animal Bites
      • Mosquitoes
      • Rodents
      • Ticks
    • Care Connect
    • Childhood Lead Poisoning
    • Chronic Disease Prevention
      • Tobacco & Vapor Product Prevention
    • Clinics
      • Back-To-School Clinics
      • Immunization Survey
      • Immunization Clinic
      • Sexual Health Clinic
    • Coalitions & Committees
      • Behavioral Health Committee
      • Community of Hope
      • Food Access & Security Coalition
      • Health Equity & Access
      • Oral Health Coalition
      • Perinatal Collaborative
      • Safe & Healthy Aging Coalition
      • Safe Kids Benton-Franklin
      • Calendar
    • Communicable Disease Prevention & Control
      • HIV Case Management and Prevention Services
      • Report An Illness
    • Community & Family Health
      • Children & Youth with Special Healthcare Needs
      • Trauma Informed Approaches
    • Emergency Preparedness
      • Lineage Fire Response
    • Food Safety
      • Applications
      • Food Safety Inspections
      • Food Worker Cards
      • Report An Illness or Food Safety Concern
      • Rules Update
    • Injury & Violence Prevention
      • Child Fatality Review
      • Child Passenger Safety
      • Drowning Prevention
      • Head Injury Prevention
      • Overdose Prevention & Response
      • Suicide Prevention
    • Investigations & Outbreaks
    • Nurse-Family Partnership
    • On-Site Sewage
      • Applications, Lists and Forms
      • Sewage System Records
      • Sewage System Inspection
      • Sewage System Maintenance/Pumping
      • Existing System Evaluations and Mortgage Certifications
      • Subdivisions
      • Rules & Regulations
    • Oral Health
      • ABCD Program
    • Pool & Water Recreation
      • Commercial Pools
      • Home Pools
    • Refugee Health
    • School Health and Safety
      • Construction
      • School Inspection Guidelines and Resources
    • Vital Records
    • Waste Disposal
      • Household Hazardous Waste
      • Medicine Disposal
      • Paint Disposal
      • Solid Waste Facilities
      • Syringe Disposal
      • Motor Oil, Antifreeze, and Tire Disposal
    • Water Health & Lab Services
      • Drinking Water
      • Toxic Algae Blooms
      • Alternative Nitrate Drinking Water Program
      • Well Water 2
      • Wastewater Management
    • Women, Infants, & Children (WIC)
      • Application for Benefits
      • Breastfeeding Peer Counseling
  • Data & Reports
    • Community Health Assessment & Improvement Plan
      • Community Health Assessment (CHA)
      • Community Health Improvement Plan (CHIP)
    • Public Health Reports and Publications
    • Data Dashboards
  • Provider Resources
    • Child Health Notes
    • Health Alerts and Advisories
    • WIC Forms
  • About Us
    • Billing
      • Payments
    • Board of Health
      • Calendar
      • Minutes & Agendas
      • Rules & Resolutions
      • Membership
      • Recordings
    • Business Services
    • Contact Us
      • Directory
      • Hours of Operation
      • Ethical Reviews
    • Evaluation & Planning
      • Accreditation
      • Quality Improvement
      • Strategic Plan
      • Community Health Survey
    • Grants
    • Human Resources
      • Benefits
      • Employment
      • Volunteers & Internships
    • Leadership
    • Media Hub
      • Media Releases
      • Media Requests
    • Public Information & Disclosures
      • Annual Report
      • Privacy
      • RCWs & WACs
      • Records
      • Terms and Conditions
    • One Health
    • Publications

WIC Forms

Benton Franklin Health District » Provider Resources » WIC Forms
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WIC Forms
WIC Forms
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How Can WIC Help Your Patients?

WIC Nutrition Program

Washington State WIC Approved Formulas

Washington WIC Medical Documentation Form – Pregnant, Breastfeeding, Nonbreastfeeding

Washington WIC Medical Documentation Form - Infants (Birth to 12 months)

Washington WIC Medical Documentation Form - Children 1 – 5 years

Additional Information

Frequently Asked Questions

  • How do I test my well water?
  • How do I get my immunization record?
  • How do I locate my septic system?
  • How do I report an illness?
  • Notice of Privacy
  • Terms and Conditions

Online Services

  • Pay My Bill
  • File a Complaint or Compliment
  • Apply for a Job
  • Public Record Request
  • How do I get a food worker card?

Helpful Links

  • Washington State Department of Health
  • Centers for Disease Control and Prevention
  • Washington State Department of Ecology
  • Guide to Community Services Bullseye
  • MMR Exemption Law Change Info
Benton Franklin Health District logo. A tree with some figures standing underneath

Contact Information

  • Kennewick

  • 7102 W. Okanogan Place
  • Kennewick, WA 99336
  • 509.460.4200
  • Contact Us
  • Pasco

  • 412 W. Clark Street
  • Pasco, WA 99301
  • 509.547.9737
  • Contact Us
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