Georgia WIC Program State Ordered Formula: New Special Formula Order Form Training Presentation to: WIC Staff Presented by: Laura Iberkleid and Barbara

Georgia WIC ProgramState Ordered Formula:

New Special Formula Order Form Training

Presentation to: WIC Staff

Presented by: Laura Iberkleid and Barbara Stahnke

Date: December 2014

Objectives

• To review all sections of the new special formula order form

• To answer questions regarding the special formula order form and ordering process

The New Form

• Phone (#1)– Previous Procedure

• Call when sending order

– Current Procedure • Email Laura Iberkleid,

Barbara Stahnke, and Denali Lord when sending an order

• Fax (#2)– Send all faxes to this

number • Depending on your

district policy and available tools, we can accept encrypted documents by e-mail.

Special Formula Order Form

• New Order (#3)– First order for

participant– Change from old

order form to new order form

– ANY change to MDF• Ounces/day• Flavor

• Diagnosis • Repeat Order (#4)

– Nothing changed since previous month’s order

– MDF has not expired

– Continue to check repeat order after 3 months


• Rush Order (#5)– Check ‘yes’ if needed by next business day, otherwise

check ‘no’– Determined by district– Deadline of 3 pm to be processed the same day for next

day delivery (Note: Not available for all products)

• Date Faxed (#6)

• SWO Notified (#7)– Notify via email– You will receive a reply within 24 hours


• MDF Reviewed and Attached (#8)– Make sure MDF is reviewed

for accuracy before sending– MDF needs to be sent each

month with order form

• Date of Next Cert Due

(#9)– Enter date and month of

next cert (including sub, mid, half)

• Next Cert Type (#10)– Select certification type

• M = Mid cert or Mid Assess (infant or woman)

• H = Half cert (child)• S = Subsequent cert (child,

woman)


• Name of WIC Participant & ID Number (#11)–Both needed

• Date of Birth (#12)–Verify this

matches DOB on MDF form

• Child, Infant, Woman (#13)–Check

appropriate line


• First Day to Use (#14)– Enter as month/day/year– Should be taken from the voucher printed– Can be entered at the time vouchers are printed

in the issuance date column of your tracking form, or found in your vouchers printed history

– You will need the voucher number and the “first day to use” each month for your order


1B 1C 1D 1E

2E1A 2B 2C 2D

3E3D

4E4D

3C3B

4B 4C

2A

3A

4A

2B 2C 3D

2E1C1B1A

3E

3B

2A

3A 3C 4D 4E

4B4A 4C

2D

1D 1E


• Voucher Code (#15)– 199 will always be the voucher code number for a State

Ordered Formula

• Voucher Number (#16)

– *NEW* Print up to 3 months at a time at certification or food package change

– Voucher receipts are signed at issuance of the vouchers– Actual vouchers are given to the participant at the time

of certification– Write in voucher number on order form instead of

sending in voucher receipt– Tracking vouchers are signed at each pickup of formula

• If Infant, Age as of first day of use date (#17)– Age in months/days– Infants only

• Feeding Type (#18)– FFF = Fully Formula Fed/Postpartum woman not

breastfeeding– SBF = Some breastfed/Postpartum woman doing some

breastfeeding– MBF = Mostly breastfed/Postpartum woman mostly

breastfeeding


• Diagnosis(es) & ICD9/10 (#19)– Should justify the formula being ordered– Both diagnosis and ICD9/10 code recommended– Refer to Julianne’s presentation and Procedures

Manual (FP 34-36)

• Name of Formula (#20)– Write in full name of formula– If more than one formula, fill out separate form for

each formula– Example: ‘Neocate Junior’ or Neocate Infant’

• Not ‘Neocate’


• Flavor (#21)– If more than one flavor requested, fill out

separate order form for each flavor – If no flavor options, enter n/a– If left blank, assumed to be unflavored

• Type of Formula (#22)– Check one or complete ‘other’

• ‘Other’ can be packets, vials, etc.



Justify RTF and/or Container Size (#23)(when other forms are available )

Justifications for FPIII & RTF• Homelessness • Unclean water • Not able to prepare formula

correctly • Better compliance • Better meets medical needs

Justifications for Non-FPIII & RTF• Homelessness • Unclean water • Not able to prepare

formula correctly

Justifications for Container Size • 2 oz nursettes vs. larger RTF containers

• Cannot finish 32oz in 48 hours

• Estimated Time on Formula (#24)– Most Restrictive

• Next certification• Planned length of use on MDF• Number of months until MDF expires



• Clinic Name, Contact Person, Phone Number (#25)– Direct phone number, if possible

• Ship Formula to (#26)– Include full shipping address and phone number of clinic that will

be receiving the formula in case of delivery problem

• Print District Contact (#27)– Name and direct phone number

• Verified by (#28)– Include name, signature, direct phone number


OR

• New Order (#3)– First order for

participant– Change from old order

form to new order form

– ANY change to MDF• Ounces/day• Flavor• Diagnosis

• Repeat Order (#4)– Nothing changed since

previous month’s order

– MDF has not expired– Continue to check

repeat order after 3 months



• NEW ORDERS (#29)a) # cans prescribed

– Use prescribed oz/day on MDF form to calculate• (oz/day) x 30 days = oz/month• (oz/month) ÷ can size = # cans prescribed • Use Common Formula Maximums to determine can size

b) # cans allowed– Use Common Formula Maximums

c) # cans on handa) Prior formula on hand from this participant and/or formula

received in your district from another participant**


Find the Common Formula Maximums athttp://dph.georgia.gov/wic-formula-resources


** # cans on hand **All formula no longer being used by the participant it was

ordered for should be placed in your formula on hand, and managed in your regular formula inventory.


• Total # cans needed (#30)– FFF Infants

• Receive the maximum number of cans allowed regardless of prescribed ounces on MDF

– MBF Infants• Maximum allowed is listed in procedures manual (FP

Attachment 25)

– Children and Women• Receive ONLY what is prescribed on MDF• Can round up to the next full can but may NEVER go over max


• Total # cans needed (#30)– Once number of cans needed to be issued

for the month is determined:• # Cans to be issued - # cans on hand = total #

cans needed

– Write in the total number of cans you need to receive from the State Office


• #31 - #33– State WIC Office to Complete– Leave blank

• Additional Information (#34)– Any information that will be helpful in

clarifying the order


• Repeat Orders (#35)– Check the month for the same MDF– Note: A revised or new MDF will be a New

Order


• Repeat Orders (#36)a) # cans prescribed

– Use prescribed oz/day on MDF form to calculate• (oz/day) x 30 days = oz/month• (oz/month) ÷ can size = # cans prescribed • Use Common Formula Maximums to determine can size

b) # cans allowed– Use Common Formula Maximums

c) # cans on hand - (including formula in stock amounts)


** # cans on hand **All formula no longer being used by the participant it was

ordered for should be placed in your formula on hand, and managed in your regular formula inventory.


• Total # cans needed (#37)– FFF infant, MBF infant, Child, or Woman?– Once number of cans needed to be issued

for the month is determined:• # Cans to be issued - # cans on hand = total #

cans needed

– Write in the total number of cans you need to receive from the State Office


• #38– State WIC Office to Complete– Leave blank

• Additional Information (#39)– Any information that will be helpful in

clarifying the order


• Next Steps (#41)– Fax packing slip to SWO– No longer need to fax voucher receipt

• File with voucher receipts for that day

– Signed voucher at formula pick-up*NEW* Keep the voucher in an easily accessible folder or box organized by participant and date.

Special Formula Order Tracking Form


• Trading Database (#42)• Common Formula Maximums (#43)

Questions

?

Documents

Georgia WIC Program State Ordered Formula: New Special Formula Order Form Training Presentation to: WIC Staff Presented by: Laura Iberkleid and Barbara