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) – Cov Neeg Amelikas thiab Cov Neeg Nyob Hauv Tebchaws Meskas Uas Thov Medi-Cal Yuav Tsum Qhia Pov Thawj Txog Kev Ua Neeg Amelikas thiab Tus Kheej
- DHCS 0002 (01/08) (Vie) – Pov Thawj Txog Kev Ua Neeg Amelikas Thiab Tus Kheej – Cov Kev Cai Tshiab Rau Cov Neeg Tau Txais Medi-Cal Uas Yog Neeg Amelikas Los Yog Neeg Hauv Tebchaws Meskas
- DHCS 0005 (02/08) (Vie) - Daim Ntawv Txais Cov Ntawv Pov Thawj Txog Kev Ua Neeg Amelikas lossis Tus Kheej
- 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) - Cov Kev Cai Pov Thawj Txog Kev Ua Neeg Amelikas thiab Kev Txheeb Xyuas Tus Kheej rau Cov Menyuam Uas Yog Neeg Amelikas lossis Neeg Tebchaws Meskas Ua Cov Tsev Neeg Noj Qab Nyob Zoo
- 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) - Cov Ntawv Pov Thawj Txog Kev Ua Neeg Amelikas lossis Daim Ntawv Qhia Tus Kheej
MC Forms: Nyab Laj
- MC 0021 (04/07) (Vie) – Daim Ntawv Pom Zoo Txuas Rau Medi-Cal Rau Cov Tsev Neeg Noj Qab Haus Huv
- MC 176 S (03/09) (Vie) – Daim Ntawv Qhia Txog Xwm Txheej Medi-Cal
- 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) – Kev Txiav Txim Siab Txhua Xyoo ntawm Medi-Cal
- MC 219 (11/15) (Vie) – Cov Lus Qhia Tseem Ceeb rau Cov Neeg Thov Medi-Cal
- MC 223 C (06/11) (Vie) – Cov Lus Qhia Ntxiv rau Cov Neeg Thov Medi-Cal Me Nyuam Xwb – Hnub Nyoog Qis Dua 18 Xyoo
- 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) – Daim Ntawv Ceeb Toom Txog Cov Ntaub Ntawv – Tsis Muaj Peev Xwm Txheeb Xyuas Kev Ua Pej Xeem/Tus Kheej ntawm Tebchaws Meskas (Tebchaws Meskas) Los Ntawm Lub Chaw Haujlwm Saib Xyuas Kev Ruaj Ntseg Hauv Zej Zog
- MC 264 (09/11) (Vie) - Kev Tsim Nyog Rau Cov Poj Niam Cev Xeeb Tub Daim Ntawv Qhia Txog Tus Neeg Mob
- 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) – Daim Ntawv Pom Zoo Medi-Cal
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