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Medi-Cal Eligibility Division (MCED) Translated Forms: Laotian

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Medi-Cal Eligibility Divison forms are listed below, alphabetically, by form number and has been translated into Laotian. 

PDF fill and print forms may be completed online and printed to hardcopy to be signed and mailed in or submitted in person to an eligibility worker for processing.

NOTE: Some links on this page are documents in Adobe Acrobat Portable Document Format (PDF); unless indicated are smaller than 2 MB. PDF documents require Adobe Reader. If you need to install or upgrade to the latest version, click the “Download Free Readers”.   


DHCS Forms: Laotian

DHCS 0001 (01/08) (Lao) - U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity

DHCS 0002 (01/08) (Lao) - Proof of Citizenship and Identity--New Requirements for Medi-Cal Beneficiaries Who Are U.S. Citizens or Nationals
DHCS 0003 (06/07) (Lao) - Affidavit of Reasonable Effort to Get Proof of Citizenship
DHCS 0004 (06/07) (Lao) - Request for California Birth Record
DHCS 0005 (02/08) (Lao) - Receipt of Citizenship or Identity Documents
DHCS 0006 (08/07) (Lao) - Proof of Citizenship and Identity
DHCS 0007 (12/07) (Lao) - Acceptable Citizenship and Identity Documents
DHCS 0008 (01/08) (Lao) - Proof of Citizenship and Identity Requirements -- For Children Who Are U.S. Citizens or Nationals Filling Out the Healthy Families/Medi-Cal Joint Application
DHCS 0009 (09/07) (Lao) - Affidavit of Identity for U.S. Citizen or National Children Under 18

DHCS 0011 (06/08) (Lao) - Proof of Acceptable Citizenship or Identity Documents



MC Forms: Laotian

MC 0021 (04/07) (Lao) - Medi-Cal to Healthy Families Bridging Consent Form


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Last modified on: 5/4/2016 8:46 AM