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Medi-Cal Daim Ntawv Qhia Txog Kev Tsim Nyog Muaj Peev Xwm muaj npe nyob rau hauv cov tsiaj ntawv hauv qab no los ntawm tus lej daim ntawv thiab tej zaum yuav suav nrog lwm hom lus yog tias muaj. PDF sau thiab luam cov ntawv tuaj yeem ua tiav hauv online thiab luam tawm rau cov ntawv tawv tawv kom kos npe thiab xa hauv lossis xa tuaj rau tus neeg ua haujlwm tsim nyog rau kev ua haujlwm.​​ 

Hloov tshiab!​​ 

Tag nrho cov kev tsim nyog tau txais kev pab rau cov poj niam cev xeeb tub yuav tam sim no muaj nyob rau hauv peb lub website rau hauv qab no:
MC 311​​ 

MC 300 Daim Ntawv Thov:​​ 

• MC 306 (11/15) – Appointment of Representative​​ 
  • Alt: Spanish (01/08)​​ 
• MC 322 (05/07) – Real and Personal Property – Supplement to Medi-Cal Mail-in Application​​ 
  • Alt: Spanish (09/07)  MC 324 (05/07) – Sneede v. Kizer Section 1931(b) Property Work SheetMC 325 (05/07) – Request for Transitional Medi-Cal (TMC) or Four Month Continuing Medi-Cal​​  
• MC 326 A (05/07) – Supplemental Security Income (SSI) Methodology Adult Income Eligibility Worksheet​​   MC 326 C (05/07) – Supplemental Security Income (SSI) Methodology Income Worksheet – Eligible Child with Ineligible Parent or Parent(s)​​   MC 327 A (05/07) – Supplemental Security Income (SSI) Program Property Worksheet Adult​​   MC 327 C (05/07) – Supplemental Security Income (SSI) Program Property Worksheet Child​​  
• MC 330 (10/24) – Newborn Referral (Not an Application for Medi-Cal (fillable)​​ 
  
  • Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thai , Ukrainian, Nyab Laj
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  • Loj Font: Lus Askiv
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• MC 337 (05/07) – 100 Hours or More Unemployed Parent Determination Work Sheet​​  
• MC 338 (05/07) – 250 Percent Income Test Work Sheet for the 250 Percent Working Disabled Program – Adults​​ 
  • Alt: Instructions  MC 338 A (05/07) – SSI/SSP Income Test Work sheet For The 250 Percent Working Disabled Program – Adults  MC 338 B (05/07) – 250 Percent Income Test Work Sheet for the 250 Percent Working Disabled Program-Child Applying with or without Ineligible Parent(s)  MC 338 C (05/07) – SSI/SSP Property Test Worksheet For The 250 Percent Working Disabled Program – Adults and Child Applicants  
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  • MC 338 J (05/07) – Premium Differential Work Sheet in the 250 Percent Working Disabled Program​​   MC 350 (05/07) – Medi-Cal Notice of Action – Approval For The Medically Needy or Medically Indigent Program Benefits​​ MC 354 (05/07) – Medi-Cal Contact Update​​ 
  • Alt: Spanish  
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• MC 355 (07/18) – Medi-Cal Request for Information​​ 
  
  • Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thaib, Ukrainian, Nyab Laj​​ 
• MC 356 (05/07) – “Safe Arms for Newborns” Medical Questionnaire​​ 
  • Alt: Spanish   MC 360 (06/07) – Notification of Medi-Cal Intercounty Transfer  MC 360 R (05/07) – Medi-Cal Intercounty Transfer Packet Receipt  MC 363 (05/07) – Medi-Cal to Healthy Families Transmittal  MC 363 S (05/07) – County Summary Transmittal  MC 364 (05/07) – California Department of Aging (CDA) Waiver Referral  MC 368 (06/07) (Chi) – Notice of Supplemental Form for Express Enrollment Applicants (Chinese)​​ 
• MC 368 (06/07) (Hmo) – Notice of Supplemental Form for Express Enrollment Applicants (Hmong)​​ 
• MC 368 (06/07) (Rus) – Notice of Supplemental Form for Express Enrollment Applicants (Russian)​​  
• MC 368 A (11/10) – Important Information for Medi-Cal Applicants​​ 
  • Alt: Spanish  MC 368 M (06/07) – Express Enrollment Supplemental Form for Medi-Cal, Healthy Families, and Healthy Kids​​ 
  • Alt: Spanish  MC 370 (06/13) – Healthy Families/Medi-Cal Joint Application Order Form MC 371 (07/09) – Additional Family Members Requesting Medi-Cal​​ 
  • Alt: Arabic, Armenian, Suav, Farsi, Hmong, Cambodian, Korean, Russian, Spanish, Tagalog, Nyab Laj​​  
• MC 372 (12/21) – Breast and Cervical Cancer Treatment Program (BCCTP)​​ 
  
  • Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thaib, Ukrainian, Nyab Laj​​ 
• MC 373 (12/21) – County Referral to the Breast and Cervical Cancer Treatment Program​​ 
  
• MC 380 (06/18) – Notice of Authorized Representative Appointment​​ 
  
  • Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thaib, Ukrainian, Nyab Laj ​​ 
• MC 381 (06/18) – Authorized Representative Cancellation Letter​​ 
  • Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thaib, Ukrainian, Nyab Laj ​​ 
• MC 382 (06/18) – Appointment of Authorized Representative Form​​ 
  • Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thaib, Ukrainian, Nyab Laj ​​ 
• MC 383 (06/18) – Authorized Representative Standard Agreement​​ 
  • Alt: Spanish​​