Pawg Neeg Tsim Nyog Tau Txais Medi-Cal Cov Ntawv Txhais Lus: Lus Nyab Laj
Rov qab mus rau Phau Ntawv Txhais Lus Lub Ntsiab
Cov ntawv thov Medi-Cal Eligibility Division (MCED) tau teev nyob rau hauv qab no, raws li cov tsiaj ntawv, los ntawm tus lej ntawm daim ntawv thiab tau muab txhais ua lus Nyab Laj lawm.
Cov ntawv sau thiab luam tawm PDF tuaj yeem ua tiav hauv online thiab luam tawm ua daim ntawv theej kom tau kos npe thiab xa ntawv lossis xa mus rau tus neeg ua haujlwm tsim nyog rau kev ua tiav.
DHCS Forms: Nyab Laj
- DHCS 0001 (01/08) (Vie) – U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity
- DHCS 0002 (01/08) (Vie) – Proof of Citizenship and Identity–New Requirements for Medi-Cal Beneficiaries Who Are U.S. Citizens or Nationals
- DHCS 0005 (02/08) (Vie) – Receipt of Citizenship or Identity Documents
- DHCS 0007 (12/07) (Vie) - Cov Ntaub Ntawv Txog Kev Ua Neeg Amelikas Thiab Kev Txheeb Xyuas Tus Kheej Uas Txais Tau
- DHCS 0008 (01/08) (Vie) – Proof of Citizenship and Identity Requirements for Children Who Are U.S. Citizens or Nationals Filling Out the Healthy Families
- DHCS 0009 (09/07) (Vie) - Daim Ntawv Pov Thawj Qhia Txog Tus Kheej rau Cov Menyuam Yaus Asmeskas lossis Cov Menyuam Yaus Hauv Tebchaws uas Muaj Hnub Nyoog Qis Dua 18 Xyoo
- DHCS 0011 (06/08) (Vie) – Proof of Citizenship or Identity Documents
MC Forms: Nyab Laj
- MC 0021 (04/07) (Vie) – Medi-Cal to Healthy Families Bridging Consent Form
- MC 176 S (03/09) (Vie) – Medi-Cal Status Report
- MC 209 (05/12) (Vie) – Kev hloov pauv rau koj qhov kev pab them nqi Medi-Cal thaum koj cev xeeb tub thiab tom qab koj yug me nyuam
- MC 210 RV (05/11) (Vie) – Medi-Cal Annual Redetermination
- MC 219 (11/15) (Vie) – Important Information for Persons Requesting Medi-Cal
- MC 223 C (06/11) (Vie) – Supplemental Statement of Facts for Medi-Cal Child Applicant Only – Under Age 18
- MC 223 (10/09) (Vie) – Cov lus qhia ntxiv ntawm tus neeg thov rau Medi-Cal Tus Neeg Thov Kev Pab Neeg Laus Xwb
- MC 239 DRA-6 (02/10) (Vie) – Information Notice – Unable to Verify United States (U.S.) Citizenship/Identity Through The Social Security Administration
- MC 264 (09/11) (Vie) – Presumptive Eligibility for Pregnant Women Program Patient Fact Sheet
- MC 371 (06/09) (Vie) – Cov Tswv Cuab Ntxiv Hauv Tsev Neeg Uas Thov Medi-Cal
- MC 372 (12/21) (Vie) - Daim Ntawv Qhia Txog Kev Kho Mob Cancer Mis thiab Cervical Cancer (BCCTP)
- MC 4035 (04/08) (Vie) – Medi-Cal Consent Form
MC Cov Ntaub Ntawv Ceeb Toom: Nyab Laj
- Daim Ntawv Ceeb Toom Txog MC 003 (05/13) (Vie) - Kev Tshuaj Xyuas Thaum Ntxov thiab Tsis Tu Ncua, Kev Kuaj Mob, thiab Kev Kho Mob