Exhibits 5A-5II

Chapter 5: Certification - MN Operations Manual

MN WIC Program

Exhibit 5-A: Minnesota WIC Program Income Guidelines
(PDF: 36KB/1 page) - revised 04/15

Exhibit 5-B, 5-C, 5-D and 5-E: ***DELETED****

Exhibit 5-F: Weight Gain Guidelines
(PDF: 84KB/2 pages)

Exhibit 5-G: Prenatal Weight Gain Grid for Underweight Women
(PDF: 55KB/1 page)

Exhibit 5-H: Prenatal Weight Gain Grid for Normal Weight Women
(PDF: 52KB/1 page)

Exhibit 5-I: Prenatal Weight Gain Grid for Overweight Women
(PDF: 53KB/ 1 page)

Exhibit 5-J: HemoCue Instrument Calibration Log
(PDF: 17KB/1 page)

Exhibit 5-K, 5-L, 5-M, 5-N, 5-O, 5-P, 5-Q1, 5-Q2, 5-R, 5-S : ***DELETED***

Exhibit 5-T: Minnesota WIC Risk Criteria - HuBERT
(PDF: 168KB/24 pages) - revised 11/12

Exhibit 5-U: Participant Priority System
(PDF: 20KB/1 page)

Exhibit 5-V: Nutrition Risk and Priority Assignment Table - HuBERT
(PDF: 52KB/4 pages) - revised 11/12

Exhibit 5-W: Homeless Facility Assessment Form
(PDF: 49KB/2 pages)

Exhibit 5-X: ***DELETED***

Exhibit 5-Y: Request for Medical Follow-up - revised 04/08

Exhibit 5-Z: WIC ID/VOC Folder
(PDF: 268KB/2 pages) - revised 10/14

Exhibit 5-AA: Local Self Assessment Breastfeeding Checklist
(PDF: 57KB/3 pages)

Exhibit 5-BB: Documentation Education Tool
(PDF: 54KB/1 page)

Exhibit 5-CC, 5-DD, 5-EE: ***DELETED***

Exhibit 5-FF: Welcome to WIC Handbook
(PDF: 901KB/9 pages) - revised 5/11

Exhibit 5-GG: Sample Letter of Ineligibility

Exhibit 5-HH: Calculating Gestation - Adjusted Age
(PDF: 267KB/1 page)

Exhibit 5II: Minnesota WIC Program Certification Form
(PDF: 89KB/2 pages)

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