To Assist You With Referrals

View any document by clicking on the title. You can print a document or contact us to request copies.

• Referral for Pregnant Woman

• Referral for Postpartum Woman

• WIC Pediatric Referral Form

• Instructions for Completing Pediatric Referral Form

• Pediatric Referral and Special Dietary Request Form (SDR Form)

• Instructions for Completing SDR Form

• When Your Medi-Cal Patient Needs Formula for Medical Conditions (FMC), also known as Therapeutic Formula

You may find these pages helpful:

• Our Breastfeeding Policy

• Formula for Medical Conditions

We are available to provide information and assistance:

Requests for Documents
Charlene Walters, BA, CLE
Supervisor, WIC Outreach and Provider Relations
cwalters@slahp.org
(323) 757-7244 ext. 298

Maria Padilla-Castro, BS
Chief, WIC Outreach and Provider Relations
mpadilla-castro@slahp.org
(323) 905-1252

Lactation Services
Breastfeeding Helpline
(323) 905-1248

Breastfeeding
Deborah Myers, MS, CNS, CLE
Chief, Nutrition and Breastfeeding Services
(323) 905-1235
dmyers@slahp.org.

Therapeutic Formula and Special Dietary Requests
Nancy Ann Damiani, MPH, RD, CLE
Chief, Nutrition, Breastfeeding and Training
ndamiani@slahp.org
(323) 757-7244 ext. 5937