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)​​ 
• 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)​​ 
• Tsim nyog Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI) Daim Ntawv Qhia Txog Kev Tsim Nyog Rau Txhua Tus Neeg Thov: Ib Tus (s), Ob Leeg (s), thiab Me Nyuam (cov menyuam) (LTC Ib tus neeg hauv MFBU) (1MB/QI)​​ 
• 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/​​ 
• Tsim nyog Medicare Beneficiary (QMB)/Specified Low-Income Medicare Beneficiary (SLMB)/Qualifying Individual (QI) Cov Nyiaj Tau Los Tsim Nyog Ua Haujlwm, Cov khub niam txiv lossis tus neeg thov nrog tus txij nkawm tsis tsim nyog, Nrog lossis Tsis Muaj Menyuam (MC 176-2A QMB, 9MB/SL)​​ 
• 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)​​ 
• 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 Peb Lub Hlis rau Kev Kho Mob Convulsive thiab Psychosurgery Administered​​  (DHCS 1011, 11/22)​​ 

Rov qab mus rau Forms Index​​