RISK FACTOR DEFINITIONS TABLE - Infants - PDF Document

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  1. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) 103 Underweight or At Risk of Underweight Underweight: Automatically assigned by system based on data entered on the Height/Weight/Blood tab. -Birth to < 24 months: < 2.3rd percentile weight-for-length on the CDC Birth to 24 months gender specific growth Charts (using 0- 24 WHO Wt/Len grid). At Risk of Underweight: Automatically assigned by system based on data entered on the Height/Weight/Blood tab. -Birth to < 24 months: > 2.3rd percentile and < 5th percentile weight-for-length on the CDC Birth to 24 months gender specific growth charts (using 0-24 WHO Wt/Len grid). -Assigned based on a system calculation and not actual plotting. MOWINS will flag the participant’s record as high-risk: -Birth through 23 months when the weight-for-length is ≤ 2.3rd percentile on the CDC Birth to 24 months gender specific growth charts (using 0-24 WHO Len/Age grid). -Complete a SOAP Note in MOWINS. Refer to ER #2.02900. S 114 Overweight or At Risk of Overweight At Risk of Overweight: Automatically assigned by system based on Parental Body Mass Index (BMI) when an infant < 12 months of age and the biological mother’s BMI is > 30 at the time of conception or at any point in the first trimester and the mother's information is in MOWINS. Optional assignment: when BMI is based on self-reported weight and height by the parent in attendance. Manually assign for an infant < 12 months of age when mother's information is not in MOWINS and if the biological mother's BMI was > 30 at the time of conception or at any point in the first trimester. Manually assign for all infants if the biological father is present and the biological father's BMI is > 30 at the time of the infant’s certification. BMI cannot be based on measurements of the father provided by the mother. Counseling Note: It is recommended that the term “overweight” be used for documentation and risk assessment only and more neutral terms (e.g. weight disproportional to height, excess weight, BMI) be used when discussing a infant’s weight with a parent/caregiver. B 115 High Weight-for Length  Automatically assigned by system when weight-for-length measurements is > 97.7th percentile as plotted on the CDC Birth to 24 months gender specific growth charts (0-24 WHO Wt/Len grid). S 121 Short Stature or At Risk of Short Stature Short Stature: Risk factor is automatically assigned by system when infant's (Birth to < 24 months) length-for-age measurements is ≤ 2.3rd percentile as plotted on the CDC Birth to 24 months gender specific growth charts (0-24 WHO Len/Age grid). At Risk of Short Stature: Risk factor is automatically assigned by system when infant's (Birth to < 24 months) length-for-age measurements are > 2.3rd percentile and ≤ 5th percentile on the CDC Birth to 24 months gender specific growth charts (0-24 WHO Len/Age grid). MOWINS will flag an infant record as high risk when birth to < 24 months length-for-age measurements is ≤ 2.3rd percentile on the CDC Birth to 24 months gender specific growth charts (0-24 WHO Len/Age grid). -Complete a SOAP Note in MOWINS. Refer to ER #2.02900. S MOWINS - Version 2.34 Page 1 of 14

  2. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) 134 Failure to Thrive  Risk Factor is manually assigned when the presence of the condition is diagnosed by a physician, as self-reported by applicant, participant or caregiver; or as reported or documented by a physician, or someone working under physician’s orders.* MOWINS will flag participant’s record as high-risk. - Complete a SOAP Note in MOWINS. Refer to ER #2.02900. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider.  C 135 Slowed/Faltering Growth Pattern  Infant < 14 days old -Risk Factor is automatically assigned when there is excessive weight loss after birth (≥ 7% birth weight).  Infants 14 days to 6 months old - Risk factor is automatically assigned by system based on any weight loss. Use 2 separate weights taken at least 8 weeks apart.  MOWINS will flag participant’s record as high-risk. -Complete a SOAP Note in MOWINS. Refer to ER #2.02900. S 141 Low Birth Weight or Very Low Birth Weight  Risk factor is automatically assigned by system when birth weight entered on the Health Information tab is ≤5 lb. 8 oz. MOWINS will flag participant’s record as high-risk all infant participants with a birth weight ≤3 lb. 5 oz.. - Complete a SOAP Note in MOWINS. Refer to ER #2.02900. S 142 Preterm or Early Term Delivery Risk factor is automatically assigned by system if the difference between the LMP date of the mother and the actual date of birth of the infant is ≤38 6/7 weeks as entered on the Health Information tab. There must be a 2-way link for this risk factor to be system-assigned. - Preterm: Delivery of an infant born ≤36 6/7 weeks gestation. - Early Term: Delivery of an infant born ≥37 0/7 and ≤38 6/7 weeks gestation. Risk Factor is manually assigned when infant is not linked to a mother. MOWINS will flag participant’s record for infants who are preterm as high-risk. - Complete a SOAP Note in MOWINS. Refer to ER #2.02900. B 151 Small for Gestational Age  Risk factor is Risk Factor is manually assigned when the presence of the condition is diagnosed by a physician or someone working under physician’s orders or as self-reported by applicant, participant or caregiver.* * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C MOWINS - Version 2.34 Page 2 of 14

  3. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) 153 Large for Gestational Age  Risk factor is automatically assigned by system when the birth weight is ≥ 9 pounds (> 4000 grams), which was entered on the Health Information tab.  Risk Factor is manually assigned when diagnosed by a physician or someone working under physician’s orders or as self-reported by applicant, participant or caregiver.* * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. B 201 Low Hemoglobin/Low Hematocrit  Infants 6-12 months of age: <11.0/ 33.0 hgb/hct.  Risk factor is automatically assigned by system based on data entered on the Health Information and Height/Weight/Blood tab as well as altitude set behind the scenes in MOWINS.  MOWINS will flag participant’s record as high-risk all infant participants with hemoglobin readings <10.0gm/100 ml or a hematocrit < 31%. - Complete a SOAP Note in MOWINS. Refer to ER #2.02900. S 211 Elevated Blood Lead Levels  Risk factor is automatically assigned by system when blood levels ≥5 mcg/dl within the past 12 months. - Based on data entered on the Height/Weight/Blood tab.  MOWINS will flag participant’s record as high-risk. - Complete a SOAP Note in MOWINS. Refer to ER #2.02900 S 341 Nutrient Deficiency or Disease  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority of nutritional deficiencies or a disease caused by insufficient dietary intake of macro and micro nutrients. - Any currently treated or untreated nutrient deficiency or disease. These include, but are not limited to, Protein Energy Malnutrition, Scurvy, Rickets, Beriberi, Hypocalcemia, Osteomalacia, Vitamin K Deficiency, Pellagra, Xerophthalmia, and Iron Deficiency. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 342 Gastro-Intestinal Disorders  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority of nutritional deficiencies or a disease caused by insufficient dietary intake of macro and micro nutrients . C MOWINS - Version 2.34 Page 3 of 14

  4. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) - Diseases and/or conditions that interfere with the intake, digestion, and/or absorption of nutrients. The Diseases and/or conditions include, but are not limited to: gastroesphageal reflux disease (GERD), peptic ulcer, post bariatric surgery, short bowel syndrome, inflammatory bowel disease, including ulcerative colitis or Crohn’s disease, liver disease, pancreatitis, and biliary tract diseases. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. 343 Diabetes Mellitus  Risk factor is automatically assigned by system when the presence of the condition is diagnosed by a physician, as self-reported by the applicant/participant/caregiver, or as reported or documented by a physician, or someone working under a physician's orders and the ‘Diabetes Mellitus’ box is selected on the Health Information tab is selected in the CGS.* - Metabolic diseases characterized by inappropriate hyperglycemia resulting from defects in insulin secretion, insulin action or both.  This risk factor is automatically assigned by system on subsequent certifications once the infant has one certification where this risk factor was assigned. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. B 344 Thyroid Disorders  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - The medical conditions include, but are not limited to, the following: Hyperthyroidism, Hypothyroidism, Congenital Hyperthyroidism, Congenital Hypothyroidism, Postpartum Thyroiditis. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 345 Hypertension/Pre-hypertension  Risk factor is automatically assigned by system when the presence of the condition is diagnosed by a physician, as self-reported by applicant/participant/caregiver, or as reported or documented by a physician, or someone working under a physician's orders and the ‘Hypertension/Pre-Hypertension’ box is selected on the Health Information tab in the CGS.* * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in B MOWINS - Version 2.34 Page 4 of 14

  5. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. 346 Renal Disease  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Any renal disease including pyelonephritis and persistent proteinuria, but excluding urinary tract infections (UTI) involving the bladder. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 347 Cancer Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - A chronic disease whereby populations of cells have acquired the ability to multiply and spread without the usual biologic restraints. Current condition, or the treatment for this condition, must be severe enough to affect nutritional intake. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider.  C 348 Central Nervous System Disorders  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Conditions which affect energy requirements and may affect the individual’s ability to feed self, which alters the nutritional status metabolically, mechanically, or both. Includes, but is not limited to: epilepsy, cerebral palsy (CP), multiple sclerosis (MS), Parkinson’s disease and neural tube defects (NTD), such as spina bifida or myelomeningocele. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C MOWINS - Version 2.34 Page 5 of 14

  6. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) 349 Genetic and Congenital Disorders Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Hereditary or congenital condition at birth that causes physical or metabolic abnormality. May include, but is not limited to, cleft lip or palate, Down’s syndrome, thalassemia major, sickle cell anemia (not sickle cell trait) and muscular dystrophy. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider.  C 351 Inborn Errors of Metabolism  Inherited metabolic disorders caused by a defect in the enzymes or their co-factors that metabolize protein, carbohydrate, or fat. Inborn errors of metabolism (IEM) Generally refers to gene mutations or gene deletions that alter metabolism in the body, including, but not limited to: Amino Acid Disorders, Organic Acid Metabolism Disorders, Fatty Acid Oxidation Disorders, Lysosomal Storage Diseases, Urea Cycle Disorders, Carbohydrate Disorders, Peroxisomal Disorders, Mitochondrial Disorders.  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 352a Infectious Diseases - Acute  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. The infectious disease must be present within the past six months. - A disease which is characterized by a single or repeated episode of relatively rapid onset and short duration. Infectious diseases come from bacteria, viruses, parasites, or fungi and spread directly or indirectly from person to person. Infectious diseases may also be zoonotic, which are transmitted from animals to humans, or vector-borne, which are transmitted from mosquitoes, ticks, and fleas to humans. These diseases and/or conditions include, but are not limited to (an extensive listing of infectious diseases can be found at: http://www.nlm.nih.gov/medlineplus/infections.html) Most Common Acute Infectious Diseases Hepatitis A Listeriosis Hepatitis E Pneumonia Meningitis (Bacterial/Viral) Bronchitis (3 episodes in last 6 months) Parasitic Infections C MOWINS - Version 2.34 Page 6 of 14

  7. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. 352b Infectious Diseases - Chronic  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Conditions likely lasting a lifetime and require long-term management of symptoms. Infectious diseases come from bacteria, viruses, parasites, or fungi and spread directly or indirectly, from person to person. Infectious diseases may also be zoonotic, which are transmitted from animals to humans, or vector-borne, which are transmitted from mosquitoes, ticks, and fleas to humans. These diseases and/or conditions include, but are not limited to (an extensive listing of infectious diseases can be found at: http://www.nlm.nih.gov/medlineplus/infections.html). Chronic Infectious Diseases HIV Human Immunodeficiency Virus AIDS Acquired Immunodeficiency Syndrome Hepatitis D * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C Hepatitis B Hepatitis C 353 Food Allergies  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Adverse immune response to a food or a hypersensitivity that causes adverse immunologic reaction. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 354 Celiac Disease  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. C MOWINS - Version 2.34 Page 7 of 14

  8. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) - Also known as Celiac Sprue, Gluten Enteropathy or Non-tropical Sprue Celiac Disease (CD) is an autoimmune disease precipitated by the ingestion of gluten (a protein found in wheat, rye, & barley) that results in damage to the small intestine & malabsorption of the nutrients from food). * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. 355 Lactose Intolerance  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Lactose intolerance is the syndrome of one or more of the following: diarrhea, abdominal pain, flatulence, and/or bloating, that occurs after lactose ingestion. - Documentation should indicate that the ingestion of dairy products causes the symptoms and the avoidance of such dairy products eliminates them. Lactose intolerance occurs when there is an insufficient production of the enzyme lactase. Lactase is needed to digest lactose. Lactose in dairy products that is not digested or absorbed is fermented in the small intestine producing any or all of the following GI disturbances: nausea, diarrhea, abdominal bloating, cramps. Lactose intolerance varies among and within individuals and ranges from mild to severe. - Note: If symptoms are well documented by the competent professional authority, self-reporting of diagnosis or physician/health care provider documentation is not required. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow- up plans with the health care provider. C 356 Hypoglycemia  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Hypoglycemia can occur as a complication of diabetes, as a condition in itself, in association with other disorders, or under certain conditions such as early pregnancy, prolonged fasting, or long periods of strenuous exercise. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C MOWINS - Version 2.34 Page 8 of 14

  9. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) 357 Drug Nutrient Interactions  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Use of prescription or over-the-counter drugs or medications that have been shown to interfere with nutrient intake or utilization, to an extent that nutritional status is compromised. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 359 Recent Major Surgery, Physical Trauma, Burns  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Major surgery, physical trauma, or burns severe enough to compromise nutritional status. Any occurrence: within the past 2 (≤ 2) months may be self-reported, more than 2 (> 2) months previous must have the continued need for nutritional support diagnosed by a physician or a health care provider working under the orders of a physicians. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 360 Other Medical Conditions  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Diseases or conditions with nutritional implications that are not included in any of the other medical conditions. The current condition, or treatment for the condition, must be severe enough to affect nutritional status. Includes, but is not limited to: juvenile rheumatoid arthritis, lupus erythematosus, cardiorespiratory diseases, heart disease, cystic fibrosis, persistent asthma (moderate or severe) requiring daily medication. NOTE: This criterion will usually not be applicable to infants for the medical condition of asthma. In infants, asthma-like symptoms are usually diagnosed as bronchiolitis with wheezing which is covered under Criterion #352, Infectious Diseases. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C MOWINS - Version 2.34 Page 9 of 14

  10. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) 362 Developmental, Sensory or Motor Disabilities  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. - Developmental, sensory or motor disabilities that restrict the ability to chew or swallow food or require tube feeding to meet nutritional needs. Includes, but is not limited to, minimal brain function, feeding problems due to a developmental disability such as pervasive development disorder (PDD) which includes autism, birth injury, head trauma, brain damage and other disabilities. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow-up plans with the health care provider. C 381 Oral Health Conditions  Risk Factor is manually assigned when: - There is presence of oral health conditions diagnosed, documented, or reported by a physician, dentist, or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. Oral health conditions include, but are not limited to: o Dental caries, often referred to as “cavities” or “tooth decay”, is a common chronic, infectious, transmissible disease resulting from tooth-adherent specific bacteria, that metabolize sugars to produce acid which, over time, demineralizes tooth structure o Periodontal diseases are infections that affect the tissues and bone that support the teeth. Periodontal diseases are classified according to the severity of the disease. The two major stages are gingivitis and periodontitis. Gingivitis is a milder and reversible form of periodontal disease that only affects the gums. Gingivitis may lead to more serious, destructive forms of periodontal disease called periodontitis. o Tooth loss, ineffectively replaced teeth or oral infections which impair the ability to ingest food in adequate quantity or quality.  Document how the oral assessment was performed and the results in the general/SOAP notes. C 383 Neonatal Abstinence Syndrome  Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome that occurs among drug-exposed (primarily opioid-exposed) infants as a result of the mother’s use of drugs during pregnancy. NAS is a combination of physiologic and neurologic symptoms that can be identified immediately after birth and can last up to 6 months after birth. - This condition must be present within the first 6 months of birth.  Manually assigned when the presence of the condition is diagnosed, documented, or reported by a physician or someone working under a physician's orders, or as self-reported by applicant/participant/caregiver*; or symptoms must be well documented by the competent professional authority. * Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow- up plans with the health care provider. C MOWINS - Version 2.34 Page 10 of 14

  11. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) 411 Inappropriate Nutrition Practices for Infants (1 – 11 months)  Risk Factor is manually assigned when routine use of feeding practices may result in impaired nutrient status, disease, or health problems. 1.Routinely using a substitute(s) for human milk or for FDA approved iron-fortified formula as the primary nutrient source during the first year of life, 2.Routinely using nursing bottles or cups improperly, 3.Routinely offering complementary foods or other substances that are inappropriate in type or timing,* 4.Routinely using feeding practices that disregard the developmental needs or stage of the infant 5.Feeding foods to an infant that could be contaminated with harmful microorganisms or toxins 6.Routinely feeding inappropriately diluted formula, 7.Routinely limiting the frequency of nursing of the exclusively breastfed infant when human milk is the sole source of nutrients, 8.Routinely feeding a diet very low in calories and/or essential nutrients, 9.Routinely using inappropriate sanitation in preparation, handling, and storage of expressed human milk or formula, 10.Feeding dietary supplements with potentially harmful consequences, 11.Routinely not providing dietary supplements recognized as essential by national public health policy when an infant’s diet alone cannot meet nutrient requirements. *Complementary foods are any foods or beverages other than human milk or infant formula. C 428* Dietary Risk Associated with Complementary Feeding Practices  Risk Factor is manually assigned for infants 4 to 12 months; this is a presumed risk. - An infant is at risk of inappropriate complementary feeding if they have begun, or are expected to begin consuming complementary foods and beverages, eating independently, weaning from breast milk or infant formula, or transitioning from a diet based on infant/toddler foods to one based on the Dietary Guidelines for Americans. - A complete nutrition assessment for risk #411, Inappropriate Nutrition Practices for Infants must be completed prior to assigning this risk factor. This can be assigned with other dietary risk factor assignment. - Can be assigned along with risk factor 411. *NOTE: A WIC Certifier cannot assign this risk factor. C 501 Possibility of Regression  Risk Factor is manually assigned when a participant could regress in their nutrition/health status. Cannot be used: - At the initial certification - Consecutively per risk factor - If participant can be certified for other risk factors (401 shall be assigned before 501). - If participant was certified using only the following risk factors during the last certification period: o 501 and 502 * A WIC Certifier cannot assign risk factor. 502 Transfer of Certification  Risk factor is automatically assigned by system when the “VOC” check box is selected on the Applicant Prescreening Window or through the VOC Certification option on the Participant Activities menu. - Person with current valid Verification of Certification (VOC) document from another State or local agency. S MOWINS - Version 2.34 Page 11 of 14

  12. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) - The VOC is valid until the certification period expires (See E.R. # 3.03500) and shall be accepted as proof of eligibility for program benefits and their FI cycle should remain as determined by the other state. 603 Breastfeeding Complications  Risk Factor is manually assigned when a breastfed infant displays any of the following complications or potential complications: - Jaundice, weak or ineffective suck, difficulty latching onto mother’s breast, inadequate stooling (for age, as determined by a physician or other health care professional) and/or less than 6 wet diapers per day. C 701 Infant Up to 6 Months Old of WIC Mother, or of a Woman Who Would Have Been Eligible During Pregnancy  Risk Factor is manually assigned for all infant <six months of age and/or if his/her mother was a program participant during pregnancy or if the mother would have met one of the prenatal risk factors other than risk factors 401 and 427 during her pregnancy.  Document mother’s risk factor(s) in infant’s record in MOWINS. C 702 Breastfeeding Infant of Woman at Nutritional Risk C Risk Factor is manually assigned when a breastfeeding infant’s mother meets one of the woman risk factors other than Risk Factor 601 (Breastfeeding Mother of Infant at Nutritional Risk). Document mother’s risk factor(s) in infant’s record in MOWINS. Homelessness  Risk factor is automatically assigned by system when the “Homeless” check box is selected on the Demographics tab. - Homelessness is when an infant lacks a fixed and regular nighttime residence; or whose primary nighttime residence is: o a supervised publicly or privately operated shelter (including a welfare hotel, congregate shelter, or a shelter for victims of domestic violence) designed to provide temporary living accommodations; o an institution that provides temporary residence for individuals intended to be institutionalized; o a temporary accommodation of not more than 365 days in the residence of another individual; or o a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.  System will default a homeless food package.   801 S 802 Migrancy  Automatically assigned by system when the “Migrant” check box is selected on the Demographics tab. - Infants who are members of families which contain at least one individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode. A woman or an infant/child whose primary caregiver is assessed to have a limited ability to make appropriate feeding decisions and/or prepare food. Risk Factor is manually assigned when the primary caregiver is assessed to have a limited ability to make appropriate feeding decisions and/or prepare food. Examples include, but are not limited to, a woman or an infant/child of caregiver with the following: - Documentation or self-report of misuse of alcohol, use of illegal substances, use of marijuana, or misuse of prescription medications. - Mental illness, including clinical depression diagnosed, documented, or reported by a physician or psychologist or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. - Intellectual disability diagnosed, documented, or reported by a physician or psychologist or someone working under a physician’s orders, or as self-reported by applicant/participant/caregiver. S 902 C MOWINS - Version 2.34 Page 12 of 14

  13. RISK FACTOR DEFINITIONS TABLE - Infants Risk Factors 103, 121, 134, 135, 141 & 142 (<24 months), 201, & 211 are high risk and require a SOAP note. Risk Factor Criteria Risk Factor Number Assignment Method (S-System; C-CPA; B- Both) - - - Physical disability to a degree which impairs ability to feed infant/child or limits food preparation abilities. ≤ 17 years of age. Document the concern to why the primary caregiver has limited feeding decisions in the general/SOAP note. *Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis should prompt the CPA to validate the presence of the condition by asking more pointed questions related to that diagnosis. The certifying staff shall document in general/SOAP notes the doctor’s name and contact information, whether the condition is being controlled by diet or medication, and any follow- up plans with the health care provider. 904 Environmental Tobacco Smoke [ETS] Exposure  Risk factor is automatically assigned by system “Yes” is selected for the ‘Household Smoking’ field on the AdditionalInfo1 tab found on the Demographics tab - LWP staff has asked if anyone living in the household smokes inside the home.  System automatically assigns this risk factor to all members of the household. S MOWINS - Version 2.34 Page 13 of 14