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Milk to Go for Providers

NWMMB has three programs to meet the needs of outpatient families. Milk volume for each program is based on availability and is subject to change. Milk volumes below are valid for prescriptions written on or after today's date.

 

Please choose from the menu below to access the prescription forms and upload documents link. You may also fax documents to 503-469-0962.

photo of baby smiling

THE BABY IS UNDER 4 WEEKS OLD

Up to 20 oz per baby,
one time only*

An RX is required

*volume is based on milk availability and prioritization of hospitalized infants

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​Up to 60 oz per baby, one time only​*

An RX and chart notes are required

*volume is based on milk availability and prioritization of hospitalized infants

photo of premature baby

THE BABY IS UNDER 8 WEEKS OLD AND WAS:
 

  • born premature (<35weeks)

  • spent time in the NICU

  • IUGR

  • SGA

  • has significant weight loss (>10% at 4+ weeks)

photo of smiling baby with mother

THE BABY HAS A CRITICAL MEDICAL NEED:

Please see a list of critical medical needs here

 

 

Volume is based on need and availability

An RX, Statement of Medical Need, and chart notes are required

The baby is under 8 weeks old AND was:

  • born premature (<35weeks)

  • IUGR

  • SGA

  • has significant weight loss or

  • spent time in the NICU

Up to 100 oz per baby, one time only

An RX and chart notes are required.

Looking for additional information about outpatient milk orders?

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