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Covered by Exception:
* Special Authorization Form Completed by Registered Dietitian (AB Government Programs)
** Needs Registered Dietitian Recommendation or Physician Prescription (NIHB)

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Family Support for Children with Disabilities (FSCD) is contract based and subject to approval


Formula Formula Category AISH (Assured Income for the Severely Handicapped) Income Support Alberta Child Health Benefits Alberta Adult Health Benefits Children's Services Alberta Blue Cross Non-Group Coverage Interim Federal Health Program for refugees (IFHP) Non-Insured Health Benefits (NIHB)
Ketocal 4:1 Liquid Vanilla Pediatric, Adult, Oral Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
Ketocal Powder Pediatric, Adult Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
KetoVie 3:1 Unflavored Pediatric, Adult, Oral Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
KetoVie 4:1 Vanilla Pediatric, Adult, Oral Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
KetoVie Peptide 4:1 Infant, Pediatric, Oral Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
Lipistart Infant, Pediatric Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered
Liquid Protein Infant, Pediatric, Adult, Modules Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
MCT Oil Oral Liquid Modules Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
Neocate Infant DHA/ ARA Powder Infant, Oral Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **
Neocate Junior Powder Pediatric Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Covered By Exception * Not Covered Covered By Exception * Covered By Exception **