georgia wic program state ordered formula: new special formula order form training presentation to:...
TRANSCRIPT
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
Special Formula Order Form
• 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
Special Formula Order Form
• 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)
Special Formula Order Form
• 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
Special Formula Order Form
• 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
Special Formula Order Form
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
Special Formula Order Form
• 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
Special Formula Order Form
• 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’
Special Formula Order Form
• 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.
Special Formula Order Form
Special Formula Order Form
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
Special Formula Order Form
Special Formula Order Form
• 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
Special Formula Order Form
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
Special Formula Order Form
Special Formula Order Form
• 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**
Special Formula Order Form
Find the Common Formula Maximums athttp://dph.georgia.gov/wic-formula-resources
Special Formula Order Form
** # 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.
Special Formula Order Form
• 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
Special Formula Order Form
• 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
Special Formula Order Form
• #31 - #33– State WIC Office to Complete– Leave blank
• Additional Information (#34)– Any information that will be helpful in
clarifying the order
Special Formula Order Form
• Repeat Orders (#35)– Check the month for the same MDF– Note: A revised or new MDF will be a New
Order
Special Formula Order Form
• 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)
Special Formula Order Form
** # 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.
Special Formula Order Form
• 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
Special Formula Order Form
• #38– State WIC Office to Complete– Leave blank
• Additional Information (#39)– Any information that will be helpful in
clarifying the order
Special Formula Order Form
• 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
Special Formula Order Form
• Trading Database (#42)• Common Formula Maximums (#43)
Questions
?