Cov Ntawv Los Ntawm Lub Npe - Q
- Kev Tsim Nyog Tsis Muaj Peev Xwm Ua Haujlwm Ib Tus Neeg (QDWI) Cov Nyiaj Tau Los Tsim Nyog Ua Haujlwm-Cov Lus Qhia (MC 176 QDWI, 05/07)
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Tsim nyog Cov Neeg Tsis Muaj Peev Xwm Ua Haujlwm Tus Kheej (QDWI) Daim Ntawv Ua Haujlwm (MC 176 QDWI-2, 05/07)
- Tsim nyog Medicare Beneficiary (QMB) xa mus (MC 176 QMB-3, 05/07)
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Daim Ntawv Ua Haujlwm Tsim Nyog Rau Medicare Tus Neeg Tau Txais Kev Pab (QMB)/Tus Neeg Tau Txais Kev Pab Medicare Uas Muaj Nyiaj Tsawg (SLMB)/Tus Neeg Tau Txais Kev Pab (QI) Rau Txhua Tus Neeg Thov: Tus (cov) Neeg, Cov Niam Txiv, thiab Cov Menyuam (Tus Neeg LTC hauv MFBU) (MC 176-1 QMB/SLMB/QI, 05/07)
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Tsim nyog Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Individual Income Eligibility Work Sheet, Me Nyuam Ua Ntawv Thov nrog lossis tsis tsim nyog Niam Txiv (MC 176-2B QMB/SLMB/QI, 05/
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Daim Ntawv Ua Haujlwm Txog Kev Tsim Nyog Tau Txais Medicare (QMB)/Tus Neeg Tau Txais Medicare Uas Muaj Nyiaj Tsawg (SLMB)/Tus Neeg Tsim Nyog Tau Txais Kev Pab Nyiaj Txiag (QI), Cov Niam Txiv lossis Tus Neeg Thov uas Muaj Tus Txij Nkawm/Poj Niam Tsis Muaj Menyuam, Muaj lossis Tsis Muaj Menyuam (MC 176-2A QMB/SLMB/QI, 09/08)
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Tsim nyog Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Property Work Sheet, Adult (MC 176 PA QMB/SLMB/QI, 09/08)
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Tsim nyog Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI)Property Work Sheet, Child (MC 176 PC QMB/SLMB/QI, 05/07)
- Daim Ntawv Thov Kev Pabcuam Tsim Nyog rau Presumptive Eligibility Participation (MC 311, 10/07)
- Daim Ntawv Qhia Txog Kev Kho Mob Qaug Dab Peg thiab Kev Phais Mob Hlwb Txhua Peb Hlis (DHCS 1011, 11/22)
Rov qab mus rau Forms Index
