Special Supplemental Nutrition Program For Women, Infants, and Children Colorado WIC Formula Guide And WIC-Eligible Medical Foods Product Guide Colorado Department of Public Health and Environment Nutrition Services/WIC Program 4300 Cherry Creek Drive South Denver, Colorado 80246-1530 (303) 692-2400 DUN #878208826 October 2013 Table of Contents Introduction Page Colorado WIC-Approved Infant Formulas & Medical Foods ------------------------------------------------------------- 1 Classifications of Colorado WIC-Approved Formulas and Medical Foods ------------------------------------------------ 1 Formulas & Medical Foods Not Authorized by WIC ---------------------------------------------------------------------- 3 Product List Product List Introduction -------------------------------------------------------------------------------------------------- 1 USDA Maximum Monthly Formula Allowance --------------------------------------------------------------------------- - 2 Maximum monthly amount of formula authorized by Colorado WIC --------------------------------------------------- 3 Maximum monthly amount of metabolic formula authorized by Colorado WIC ---------------------------------------- 5 Product List: Table of Contents x ACIDOPHILUS COW’S MILK ------------------------------------------------------------------------------------------------- 7 x BOOST HIGH PROTEIN ------------------------------------------------------------------------------------------------------- 8 x BOOST KID ESSENTIALS 1.5 ------------------------------------------------------------------------------------------------- 9 x BOOST KID ESSENTIALS 1.5 with fiber ----------------------------------------------------------------------------------- 9 x BRIGHT BEGINNINGS SOY PEDIATRIC DRINK --------------------------------------------------------------------------- 10 x COMPLEAT PEDIATRIC ------------------------------------------------------------------------------------------------------- 11 x COW’S MILK, PASTEURIZED ------------------------------------------------------------------------------------------------ 12 x DAIRY EASE --------------------------------------------------------------------------------------------------------------------- 13 x E028 SPLASH ------------------------------------------------------------------------------------------------------------------- 14 x ELECARE INFANT -------------------------------------------------------------------------------------------------------------- 15 x ELECARE JUNIOR -------------------------------------------------------------------------------------------------------------- 16 x ENFAGROW SOY TODDLER ------------------------------------------------------------------------------------------------- 17 x ENFAMIL A.R. ------------------------------------------------------------------------------------------------------------------- 18 x ENFAMIL ENFACARE ---------------------------------------------------------------------------------------------------------- 19 x ENFAMIL GENTLEASE--------------------------------------------------------------------------------------------------------- 20 x ENFAMIL PREMIUM INFANT ----------------------------------------------------------------------------------------------- 21 x ENFAMIL PROSOBEE ---------------------------------------------------------------------------------------------------------- 22 x ENFAPORT ---------------------------------------------------------------------------------------------------------------------- 23 x ENSURE ------------------------------------------------------------------------------------------------------------------------- 24 x ENSURE PLUS ------------------------------------------------------------------------------------------------------------------- 25 x GERBER GOOD START NOURISH ------------------------------------------------------------------------------------------- 26 x GOAT’S MILK ------------------------------------------------------------------------------------------------------------------- 27 x LACTAID ------------------------------------------------------------------------------------------------------------------------- 28 x NEOCATE INFANT with DHA and ARA ------------------------------------------------------------------------------------ 29 x NEOCATE JUNIOR ------------------------------------------------------------------------------------------------------------- 30 x NEOCATE JUNIOR with PREBIOTICS -------------------------------------------------------------------------------------- 31 x NUTRAMIGEN ------------------------------------------------------------------------------------------------------------------ 32 x NUTRAMIGEN with ENFLORA LGG ---------------------------------------------------------------------------------------- 33 x NUTREN JUNIOR & NUTREN JUNIOR with FIBER ---------------------------------------------------------------------- 34 x NUTREN 1.0 & NUTREN 1.0 with FIBER ---------------------------------------------------------------------------------- 35 x NUTREN 1.5 --------------------------------------------------------------------------------------------------------------------- 36 x NUTREN 2.0 --------------------------------------------------------------------------------------------------------------------- 37 x OSMOLITE 1 CAL --------------------------------------------------------------------------------------------------------------- 38 x PEDIASURE ---------------------------------------------------------------------------------------------------------------------- 39 x PEDIASURE with FIBER ------------------------------------------------------------------------------------------------------- 40 x PEDIASURE ENTERAL FORMULA ------------------------------------------------------------------------------------------- 41 x PEDIASURE ENTERAL FORMULA with FIBER and SCFOS ------------------------------------------------------------- 42 x PEDIASURE 1.5 CAL ----------------------------------------------------------------------------------------------------------- 43 x PEDIASURE 1.5 CAL with FIBER ------------------------------------------------------------------------------------------- 44 x PEPTAMEN ---------------------------------------------------------------------------------------------------------------------- 45 x PEPTAMEN JUNIOR & PEPTAMEN JUNIOR with FIBER --------------------------------------------------------------- 46 x PORTAGEN ---------------------------------------------------------------------------------------------------------------------- 47 x PREGESTIMIL ------------------------------------------------------------------------------------------------------------------- 48 x PURAMINO --------------------------------------------------------------------------------------------------------------------- 49 x SIMILAC EXPERT CARE ALIMENTUM ------------------------------------------------------------------------------------- 50 x SIMILAC EXPERT CARE NEOSURE ------------------------------------------------------------------------------------------ 51 x SIMILAC PM 60/40 ------------------------------------------------------------------------------------------------------------ 52 x SOY BEVERAGE (8th Continent) -------------------------------------------------------------------------------------------- 53 x SOY BEVERAGE (Pacific Natural Foods) ---------------------------------------------------------------------------------- 54 x TOFU (Azumaya) -------------------------------------------------------------------------------------------------------------- 55 x TOLEREX ------------------------------------------------------------------------------------------------------------------------- 56 x VIVONEX PEDIATRIC ---------------------------------------------------------------------------------------------------------- 57 x VIVONEX T.E.N. ---------------------------------------------------------------------------------------------------------------- 58 Formula Classification & Issuance Infant Formulas/Medical Foods Classified by Type ----------------------------------------------------------------------- 1 Infant Formula Ranges Cheat Sheet --------------------------------------------------------------------------------------- 4 Metabolic Formula Dilution Chart ----------------------------------------------------------------------------------------- 6 Infant Formula Decision Tree ---------------------------------------------------------------------------------------------- 8 Pediatric Formula Decision Tree ------------------------------------------------------------------------------------------ 9 Determining Nutritional Needs Changing To a New Formula ---------------------------------------------------------------------------------------------- 1 Changing To Another Formula -------------------------------------------------------------------------------------------- 2 Determining the Nutritional Needs of Children --------------------------------------------------------------------------- 3 The Reference Values: RDA and DRI ----------------------------------------------------------------------------------- 3 Assessing Nutritional Intake and Catch-up Needs of Children up to age 5 years ------------------------------------- 4 Approximate Metric Conversions ----------------------------------------------------------------------------------------- 7 Physician Authorization Form --------------------------------------------------------------------------------------------- 8 Instructions for 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