بازگشت به صفحه اصلی فرم های ترجمه شده

فرم های Medi-Cal Eligibility Division (MCED) در زیر به ترتیب حروف الفبا و بر اساس شماره فرم فهرست شده و به فارسی ترجمه شده است.

فرم‌های پرینت و پرینت PDF را می‌توان به صورت آنلاین تکمیل کرد و در نسخه چاپی چاپ کرد تا امضا و پست شود یا شخصاً برای پردازش به یک کارگر واجد شرایط ارسال شود.

فرم های DHCS: فارسی

• DHCS 0001 (01/08) (Far) – U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity
• DHCS 0002 (01/08) (Far) – Proof of Citizenship and Identity–New Requirements for Medi-Cal Beneficiaries who are U.S. Citizens or Nationals
• DHCS 0005 (02/08) (Far) – Receipt of Citizenship or Identity Documents
• DHCS 0007 (12/07) (Far) – Acceptable Citizenship and Identity Documents
• DHCS 0008 (01/08) (Far) – 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 0004 (06/07) (Far) – Request for California Birth Record
• DHCS 0005 (02/08) (Far) – Receipt of Citizenship or Identity Documents
• DHCS 0006 (08/07) (Far) – Proof of Citizenship and Identity
• DHCS 0007 (12/07) (Far) – Acceptable Citizenship and Identity Documents
• DHCS 0008 (01/08) (Far) – 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) (Far) – Affidavit of Identity for U.S. Citizen or National Children Under 18
• DHCS 0011 (06/08) (Far) – Proof of Acceptable Citizenship or Identity Documents
• MC 0021 (04/07) (Far) – Medi-Cal to Healthy Families Bridging Consent Form

فرم های ام سی: فارسی

• MC 176 S (03/09) (Far) – Medi-Cal Status Report
• MC 209 (05/12) (Far) – Changes to your Medi-Cal coverage during your pregnancy and after you give birth
• MC 210 RV (05/11) (Far) – Medi-Cal Annual Redetermination
• MC 219 (11/15) (Far) – Important Information for Persons Requesting Medi-Cal
• MC 223 C (06/11) (Far) – Supplemental Statement of Facts for Medi-Cal Child Applicant Only – Under Age 18
• MC 223 (10/09) (Far) – Applicant’s supplemental statement of facts for Medi-Cal Adult Applicant Only
• MC 239 DRA-6 (02/10) (Far) – Info Notice – Unable to Verify United States (U.S.) Citizenship/Identity Through The Social Security Administration
• MC 264 (09/11) (Far) – Presumptive Eligibility for Pregnant Women Program Patient Fact Sheet
• MC 371 (06/09) (Far) – Additional Family Members Requesting Medi-Cal
• MC 372 (12/21) (Far) – Breast and Cervical Cancer Treatment Program (BCCTP) Flyer
• MC 4035 (04/08) (Far) – Medi-Cal Consent Form

اطلاعیه های اطلاعات MC: فارسی

• MC Information Notice 003 (05/13) (Far) – Early and Periodic Screening, Diagnosis, and Treatment Services