Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
No: CT: 7
Revised: 06/12
Policy
To be certified as eligible for the WIC program applicants who have met the program
eligibility standards (refer to CT: 01) must be determined to be at nutritional risk. Only
a Competent Professional Authority (CPA) through a medical and/or nutritional
assessment may determine nutritional risk, certify for eligibility, and prescribe WIC
food packages.
Definition
Competent Professional Authority (CPA) - an individual on the staff of the local
agency authorized to determine nutritional risk and prescribe supplemental foods.
The following persons are the only persons authorized to serve as a CPA:
Physicians, Dietitians, Nutritionists (bachelor’s or master’s degree in Nutritional
Sciences, Community Nutrition, Clinical Nutrition, Dietetics, Public Health Nutrition,
or Home Economics with emphasis in Nutrition), Registered Nurses, Physician’s
Assistants, or persons who have passed the Nevada State WIC Competent
Professional Authority examination
Procedure
Nutritional risk will be documented in the participant’s file and will be used to assess
an applicant’s nutritional status and risk, tailor the food package to address
nutritional needs, design appropriate nutrition education, and make referrals to health
and social services for follow-up as necessary and appropriate.
Nutritional Assessment
A nutritional assessment is considered complete when the following indicators of
nutritional status have been evaluated;
1. Current weight and height/length (or data provided by a health care provider
no more than 60 days prior to certification, excluding infants birth
measurements)- All applicants
2. Head Circumference (or data provided by a health care provider no more
than 60 days prior to certification, excludes infants birth measurements)-Per
RD discretion only
3. Hemoglobin or hematocrit- All applicants age 9 months of age or older (Refer
to Policy CT: 12).
4. Medical/Nutritional Questionnaire-All applicants (Note: Code Sheet/Training
Tool must be utilized to evaluate and score questionnaires.)
The full nutrition assessment must be completed before nutrition education
is provided.
Nutrition Risk Conditions
Once a nutritional assessment has been completed, compile all data from the
participant’s health history, diet screen, hemoglobin and anthropometric results.
Every condition of nutritional risk will be identified and marked on the participant’s
questionnaire. In addition, all participants’ files will have supporting documentation
for every risk code (e.g., growth charts, diet and health questionnaires).
High Risk Identification and Referral
The identification and referral of High-Risk codes to the Nutritionist or Dietitian are
part of the CPAs duties. The WIC CPA is required to refer any participant assigned a
High-Risk code to their Agency Registered Dietitian or Nutritionist within 60 days of
identification. The nutritionist is then responsible for developing a Nutrition Care
Plan within that time period.
Nevada WIC Program-Certification
Page 1 of 8
Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
No: CT: 7
Revised: 06/12
State of Nevada Allowable Risk Criteria
The following is a list of the State of Nevada allowable nutrition risk criteria for each
category. Refer to the “Nutrition Risk Criteria” handout for a listing of complete
definitions and clarifications.
Nevada WIC Program-Certification
Page 2 of 8
Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
Prenatal Nutrition Risk Codes
PRIORITY 1:
ANTHROPOMETRIC/BIOCHEMICAL
101H* Underweight Women
111
Overweight Women
131H
Low Maternal Weight Gain
132H* Maternal Weight Loss During Pregnancy
133H
High Maternal Weight Gain
PRIORITY 1:
CLINICAL/HEALTH/MEDICAL
301H
Hyperemesis
302H
Gestational Diabetes
303H* History of Gestational Diabetes
304H* History of Preeclampsia
311H* History of Preterm Delivery
312H* History of Low Birthweight
321H* History of Fetal or Neonatal Loss
331H* Pregnancy at a Young Age
332
Closely Spaced Pregnancies
333
High Parity and Young Age
334
Lack of or Inadequate Prenatal Care
335H* Multifetal Gestation
336H
Fetal Growth Restriction
337
History of Birth of Large for Gestational
Age Infant
338
Pregnant Woman Currently
Breastfeeding
339H
History of Birth with Nutrition Related
Congenital or Birth Defect
341H
Nutrient Deficiency Diseases
342H
Gastro-Intestinal Disorders
343H
Diabetes Mellitus
344H
Thyroid Disorders
345H
Hypertension and/or Prehypertension
No: CT: 7
Revised: 06/12
201H*
211H
Anemia
Elevated Blood Lead Levels
346H
347H
Renal (Kidney) Disease
Cancer***
348H
349H
351H
352H
353H*
354H
355H*
356H
357
358H
359H*
360H
361H*
362H
Central Nervous System Disorders
Genetic and Congenital Disorders
Inborn Errors of Metabolism
Infectious Diseases***
Food Allergies
Celiac Disease
Lactose Intolerance
Hypoglycemia
Drug-Nutrient Interactions WIC Nutri. Only!
Eating Disorders
Recent Major Surgery, Trauma, Burns
Other Medical Conditions
Depression
Developmental Delays, Sensory or
371
372H*
381H*
904
Maternal Smoking
Alcohol and Illegal Drug Use***
Dental Problems
Environmental Tobacco Smoke Exposure
PRIORITY 4:
DIETARY
427H* Inappropriate Nutrition Practices for Women

Consuming dietary supplements with potential harmful consequences--H

Diet v low in calories or essential nutrients or impaired absorption or caloric intake after bariatric surgery--H

Pica--H

Inadequate vitamin/mineral supplementation

Potentially harmful foods ingested while pregnant
**401
Failure to Meet Dietary Guidelines for Americans
** Use 401 only after assessing for 427
PRIORITY 4:
OTHER RISKS
502
Transfer of Certification
503
Presumptive Eligibility for Pregnant Women
801
802
901H
902H
Homelessness
Migrancy
Recipient of Abuse
Woman or Infant/Child of Primary Caregiver with
Limited Ability to Make Feeding Decisions
and/or Prepare Food
H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in
computer.
Nevada WIC Program-Certification
Page 3 of 8
Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
No: CT: 7
Revised: 06/12
Breastfeeding Nutrition Risk Codes
PRIORITY 1:
ANTHROPOMETRIC/BIOCHEMICAL
101H
Underweight Women
111H
Overweight Women
PRIORITY 1:
CLINICAL/HEALTH/MEDICAL
303H* History of Gestational Diabetes
304H* History of Preeclampsia
311
History of Preterm Delivery
312
History of Low Birthweight
321
History of Fetal or Neonatal Loss
331H* Pregnancy at a Young Age
332
Closely Spaced Pregnancies
333
High Parity and Young Age
335H* Multifetal Gestation
337
History of Birth of Large for Gestational
Age Infant
339H
History of Birth with Nutrition Related
Congenital or Birth Defect
341H
Nutrient Deficiency Diseases
342H
Gastro-Intestinal Disorders
343H
Diabetes Mellitus
344H
Thyroid Disorders
345H
Hypertension and/or Prehypertension
201H*
211H
Anemia
Elevated Blood Lead Levels
346H
347H
348H
349H
351H
352H
353H*
354H
355H*
356H
357
358H
359H*
360H
361H*
362H
Renal (Kidney ) Disease
Cancer***
Central Nervous System Disorders
Genetic and Congenital Disorders
Inborn Errors of Metabolism
Infectious Diseases***
Food Allergies
Celiac Disease
Lactose Intolerance
Hypoglycemia
Drug-Nutrient Interactions WIC Nutri. Only!
Eating Disorders
Recent Major Surgery, Trauma, Burns
Other Medical Conditions
Depression
Developmental Delays, Sensory or Motor Delays
Interfering With the Ability to Eat
Pre-Diabetes
Maternal Smoking
Alcohol and Illegal Drug Use***
Dental Problems
Environmental Tobacco Smoke Exposure
363H
371
372H
381H*
904
PRIORITY 4:
DIETARY
427H* Inappropriate Nutrition Practices for Women

Consuming dietary supplements with potential harmful consequences--H

Diet very low in calories or essential nutrients or impaired absorption/caloric intake after bariatric surgery-H

Pica--H

Inadequate vitamin/mineral supplementation H
**401
Failure to Meet Dietary Guidelines for Americans
** Use 401 only after assessing for 427
PRIORITY 4:
OTHER RISKS
PRIORITY 1 OR 4: OTHER RISKS
501
Possibility of Regression (Priority must be
same as last certification)
502
Transfer of Certification
801
802
901H
902H
Homelessness (Priority 4)
Migrancy (Priority 4)
Recipient of Abuse (Priority 4)
Woman or Infant/Child of Primary Caregiver with
Limited Ability to Make Feeding Decisions
and/or Prepare Food (Priority 4)
601
Breastfeeding Mother of Infant at Nutritional
Risk (Priority must be same as at-risk infant)
Breastfeeding Complications or Potential
Complications (Priority 1)
602
H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority ___) = must be entered in
computer.
Nevada WIC Program-Certification
Page 4 of 8
Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
No: CT: 7
Revised: 06/12
Non-Breastfeeding Nutrition Risk Criteria
PRIORITY 6:
ANTHROPOMETRIC/BIOCHEMICAL
101H
Underweight Women
111H
Overweight Women
PRIORITY 4:
CLINICAL/HEALTH/MEDICAL
303H* History of Gestational Diabetes
304H* History of Preeclampsia
331H* Pregnancy at a Young Age ***
337
History of Birth of Large for Gestational
Age Infant
341H
Nutrient Deficiency Diseases
342H
Gastro-Intestinal Disorders
343H
Diabetes Mellitus
344H
Thyroid Disorders
PRIORITY 6:
CLINICAL/HEALTH/MEDICAL
311
History of Preterm Delivery (Priority 6)
312
History of Low Birth Weight (Priority 6)
321H* History of Fetal or Neonatal Loss (Priority 6)
332
Closely Spaced Pregnancies (Priority 6)
333
High Parity and Young Age (Priority 4)
335H* Multifetal Gestation (Priority 6)
339H
History of Birth with Nutrition Related Congenital
or Birth Defect (Priority 6)
201H*
211H
Anemia
Elevated Blood Lead Levels
345H
346H
347H
348H
349H
351H
352H
354H
356H
357
358H
359H*
360H
362H
363H
372H
381H*
Hypertension and/or Prehypertension
Renal (Kidney) Disease
Cancer***
Central Nervous System Disorders
Genetic and Congenital Disorders
Inborn Errors of Metabolism
Infectious Diseases***
Celiac Disease
Hypoglycemia
Drug-Nutrient Interactions WIC Nutri. Only!
Eating Disorders
Recent Major Surgery, Trauma, Burns
Other Medical Conditions
Developmental Delays, Sensory or Motor
Delays Interfering With the Ability to Eat
Pre-Diabetes
Alcohol and Illegal Drug Use***
Dental Problems
353H*
355H*
361H*
371
904
Food Allergies
Lactose Intolerance
Depression
Maternal Smoking
Environmental Tobacco Smoke Exposure
PRIORITY 6:
DIETARY
427H* Inappropriate Nutrition Practices for Women

Consuming dietary supplements with potential harmful consequences--H

Diet v low in calories or essential nutrients or impaired absorption or caloric intake after bariatric surgery--H

Pica--H

Inadequate vitamin/mineral supplementation--H
**401
Failure to Meet Dietary Guidelines for Americans
** Use 401 only after assessing for 427
PRIORITY 4 or 6: OTHER RISKS
501
Possibility of Regression (Priority 4 or 6)
must be same as last certification
502
Transfer of Certification
801
802
901H
902H
Homelessness (Priority 6)
Migrancy (Priority 6)
Recipient of Abuse (Priority 6)
Woman or Infant/Child of Primary Caregiver
with Limited Ability to Make Feeding
Decisions and/or Prepare Food (Priority 6)
H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in
computer.
Nevada WIC Program-Certification
Page 5 of 8
Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
No: CT: 7
Revised: 06/12
Child Nutrition Risk Codes
PRIORITY 3:
ANTHROPOMETRIC/BIOCHEMICAL
103H* Underweight or At Risk of Underweight
201H*
113H* Obese
211H
114
Overweight or At Risk of Overweight
121
Short Stature or At Risk of Short Stature
134H
Failure to Thrive
135H
Inadequate Growth
141H* Low Birth Weight and Very Low Birth Weight (< 2 yrs)
142
Prematurity (<2 yrs)
151H
Small for Gestational Age (< 2 yrs)
PRIORITY 3:
CLINICAL/HEALTH/MEDICAL
341H
Nutrient Deficiency Diseases
342H
Gastro-Intestinal Disorders
343H
Diabetes Mellitus
344H
Thyroid Disorders
345H
Hypertension and/or Prehypertension
346H
Renal (Kidney) Disease
347H
Cancer***
348H
Central Nervous System Disorders
349H
Genetic and Congenital Disorders
351H
Inborn Errors of Metabolism
352H
Infectious Diseases***
353H* Food Allergies
354H
Celiac Disease
355H* Lactose Intolerance
356H
357
359H*
360H
361H*
362H
381H*
382H
904
Low Hematocrit/Low Hemoglobin
Elevated Blood Lead Levels
Hypoglycemia
Drug-Nutrient Interactions WIC Nutritionist Only!
Recent Major Surgery, Trauma, Burns
Other Medical Conditions
Depression
Developmental Delays, Sensory or Motor
Delays Interfering With the Ability to Eat
Dental Problems
Fetal Alcohol Syndrome
Environmental Tobacco Smoke Exposure
PRIORITY 5:
DIETARY
425H* Inappropriate Nutrition Practices for Children

Routine feeding of inappropriate beverages as primary milk source

Routine feeding of sugar-containing fluids (e.g. soda, sweetened tea, etc)

Routine use of nursing bottles, cups, or pacifiers improperly

Routine feeding practices that disregard developmental needs or stages of child

Feeding foods that could be contaminated with harmful microorganisms

Routine feeding diet very low in calories and/or essential nutrients (e.g. vegan diet, low carb diet)--H

Feeding dietary supplements with potentially harmful consequences (e.g. excess vitamins, minerals,
herbs)--H

Routinely not providing dietary supplements recognized as essential by national public health policy
when child’s diet alone cannot meet nutrient requirements

Pica--H
**401
Failure to Meet Dietary Guidelines for Americans ≥ 2yrs Only
**428
Dietary Risk Associated with Complementary Feeding Practices – 12 Months to 23 Months Only
** Use 401 and 428 only after assessing for 425
PRIORITY 5:
OTHER RISKS
801
Homelessness
802
Migrancy
PRIORITY 3 or 5:
OTHER RISKS
501
Possibility of Regression (Priority must be
same as last certification
901H
902H
903
Recipient of Abuse
Woman or Infant/Child of Primary Caregiver With
Limited Ability to Make Feeding Decisions and/or
Prepare Food
Foster Care
502
Transfer of Certification
H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in
computer.
Nevada WIC Program-Certification
Page 6 of 8
Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
No: CT: 7
Revised: 06/12
Infant Nutrition Risk Codes
PRIORITY 1:
ANTHROPOMETRIC/BIOCHEMICAL
103H* Underweight or At Risk of Underweight
115
High Weight-for Length
121
Short Stature or At Risk of Short Stature
134H
Failure to Thrive
135H
Inadequate Growth
141H
Low Birth Weight and Very Low Birth Weight
142
Prematurity
PRIORITY 1:
CLINICAL/HEALTH/MEDICAL
341H
Nutrient Deficiency Diseases
342H
Gastro-Intestinal Disorders
343H
Diabetes Mellitus
344H
Thyroid Disorders
345H
Hypertension and/or Prehypertension
346H
Renal (Kidney) Disease
347H
Cancer***
348H
Central Nervous System Disorders
349H
Genetic and Congenital Disorders
351H
352H
Inborn Errors of Metabolism
Infectious Diseases***
151H
152H
153
201H*
211H
Small for Gestational Age
Low Head Circumference
Large for Gestational Age
Anemia
Elevated Blood Lead Levels
353H*
354H
355H*
356H
357
359H*
360H
362H
Food Allergies
Celiac Disease
Lactose Intolerance
Hypoglycemia
Drug-Nutrient Interactions WIC Nutri. Only!
Recent Major Surgery, Trauma, Burns
Other Medical Conditions
Developmental Delays, Sensory or Motor Delays
Interfering With the Ability to Eat
Dental Problems
Fetal Alcohol Syndrome
Environmental Tobacco Smoke Exposure
381H*
382H
904
PRIORITY 4:
DIETARY
411H* Inappropriate Nutrition Practices for Infants

Routinely using substitute for breastmilk or FDA approved iron-fortified formula as primary nutrient source

Routine use of nursing bottles or cups improperly

Routinely offering complementary foods or other substances inappropriate in type or timing

Routine feeding practices that disregard developmental needs or stage of infant

Feeding foods that could be contaminated with harmful microorganisms or toxins

Routinely feeding inappropriately diluted formula

Limiting frequency of nursing of exclusively breastfed infant when breastmilk is sole source of nutrients

Routine feeding of diet very low in calories and/or essential nutrients--H

Inappropriate sanitation in preparation, handling and storage of expressed breastmilk or formula

Feeding dietary supplements with potentially harmful consequences--H

Not providing dietary supplements recognized as essential by national public health policy when diet alone
Cannot meet nutrient requirements
**428
Dietary Risk Associated with Complementary Feeding Practices – 4 Months to 12 Months Only
** Use 428 only after assessing for 411
PRIORITY 1 or 2:
OTHER RISKS
501
Possibility of Regression (Priority 1)
502
Transfer of Certification
603
Breastfeeding Complications or Potential
Complications (Priority 1)
701
Infant to 6 mos of WIC Mother (Priority 2)
Or a Woman who would have been eligible
702
Breastfeeding Infant of a Woman at Nutrition Risk
(Priority must be same as at-risk mother)
703H
Infant Born of Woman w/Mental Retardation or
Alcohol or Drug Abuse (Priority 1)
PRIORITY 4:
801
802
901H
902H
903
OTHER RISKS
Homelessness
Migrancy
Recipient of Abuse
Woman or Infant/Child of Primary Caregiver
Limited Ability to Make Feeding Decisions and/or
Prepare Food
Foster Care
H = High risk. H* = Sometimes high risk. ***Breastfeeding may not be recommended. (Priority __) = must be entered in
computer.
Nevada WIC Program-Certification
Page 7 of 8
Policy: Nutrition Assessment and Risk Determination
Effective: 3/01
Imputing Risk Codes and Assigning Priority
No: CT: 7
Revised: 06/12
Enter nutrition risk codes from the applicant’s questionnaire into the participant’s
record into the WIC computer program. Usually the priority will automatically appear
in the computer, if not, enter the priority. Each risk code is listed under its priority
category. If the participant has more than one risk, enter the highest priority that
applies. General categories of nutritional risk codes are listed below with priority
levels.
Priority
A priority of I-VI must be assigned to each applicant, based on the applicant’s
nutritional risk and category, as follows:

Priority I – Pregnant and breastfeeding women and infants with
nutritionally-related medical risks. Breastfeeding women of Priority I
infants and infants of Priority I breastfeeding women.

Priority II – Infants under 6 months of age who were born to women who
were either on the WIC Program during pregnancy or who were not on
the program but would have qualified as Priority I had they been on the
program. Breastfeeding women of Priority II infants.

Priority III – Children with nutritionally-related medical risks.

Priority IV – Pregnant and breastfeeding women and infants with dietary
risks. Breastfeeding women of Priority IV infants and infants of Priority IV
breastfeeding women. Postpartum women with nutritionally-related
medical risks.

Priority V – Children with dietary risks.

Priority VI – Postpartum women with dietary and medical/nutritional
risks.
Nevada WIC Program-Certification
Page 8 of 8