Hla mus rau Cov Ntsiab Lus Tseem Ceeb
Qhib hom nkag tau yooj yim dua
Tua tawm hom siv tau ntau dua
Hla mus rau Cov Ntsiab Lus Tseem Ceeb
Medi-Cal Cov Tswv Cuab:
Khaws koj qhov kev pab them nqi kho mob
. Nkag mus rau
koj tus as-qhauj
lossis tiv tauj
koj lub nroog chaw ua haujlwm
kom hloov kho koj cov ntaub ntawv.
Tseem ceeb
Koj puas tau tso npe rau hauv Medi-Cal? Koj cov ntaub ntawv tiv tauj puas tau hloov pauv hauv ob xyoos dhau los? Muab koj lub nroog lub chaw lis haujlwm hauv koj lub nroog koj cov ntaub ntawv tiv tauj tshiab kom koj tuaj yeem nyob twj ywm.
Nrhiav koj lub county office.
Tsev
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Tsev
Hais txog DHCS
CA.gov
Ntawv qhia zaub mov
Nrhiav
Tsev
Kev pabcuam
Cov neeg
Cov kws kho mob &
Cov koom tes
Txoj Cai &
Kev cai
Cov ntaub ntawv &
Kev txheeb cais
Cov ntawv &
Kev tshaj tawm
Nrhiav
Nrhiav rau qhov chaw no:
Page Content
Forms: DHCS 4000
DHCS 4000 A (10/10) - Daim Ntawv Thov GHPP los txiav txim qhov tsim nyog
DHCS 4000 B (10/10) - GHPP Initial/Annual Income Verification
DHCS 4001 - Family PACT Program Retroactive Eligibility Certification (REC)
DHCS 4001SP - Family PACT Program Retroactive Eligibility Certification (REC-Spanish)
DHCS 4014 (06/07) - California Children's Services Medical Report
DHCS 4015 U (01/08) - Tus Neeg Mob Keeb Kwm Kev Hloov Pauv
DHCS 4026 - Daim Ntawv Pov Thawj Kev Pabcuam Kho Mob Tsis Txaus Siab - Kev Ntsuam Xyuas Cov Neeg Siv Kev Kho Mob
DHCS 4027 (06/07) - CCS Kev Pom Zoo rau Kev Pabcuam Kho Mob/Kev Kho Mob
DHCS 4087 - Master Index Rejection Notice
DHCS 4098 (09/07) - CCS Kev Kho Mob Kev Kho Mob Txoj Haujlwm Kev Ntsuam Xyuas Kev Kho Mob
DHCS 4431 - Tus Muab Kev Sib Txuas Xov Tooj thiab Daim Ntawv Thov Tus Nqi / Daim Ntawv Pom Zoo
DHCS 4461 - Family PACT Program Client Eligibility Certification (CEC)
DHCS 4461SP - Family PACT Program Client Eligibility Certification (CEC-Spanish)
DHCS 4480 (06/25) - Daim Ntawv Thov Txheeb Xyuas Qhov Tsim Nyog Tau Txais Kev Pab Cuam CCS
Alt:
Spanish
DHCS 4488 (09/15) - Kev xa mus tshiab CCS/GHPP Client Service Authorization Request (SAR)
DHCS 4489 (09/15) - CCS/GHPP Discharge Planning Service Authorization Request (SAR)
DHCS 4490 - Daim Ntawv Thov Kev Ntsuam Xyuas Kev Noj Qab Haus Huv
DHCS 4491 - Daim Ntawv Pom Zoo Muab Kev Ntsuam Xyuas Kev Noj Qab Haus Huv
DHCS 4492 - Cov ntaub ntawv kho mob tshuaj xyuas cov cuab yeej
DHCS 4493 - Cov Lus Qhia Txog Kev Tshawb Fawb Txog Kev Tshawb Fawb
DHCS 4494 - Daim Ntawv Qhia Txog Kev Tshawb Fawb Txog Kev Tshawb Fawb
DHCS 4502 - Daim Ntawv Thov Chaw Kho Mob
DHCS 4503 - Daim Ntawv Pom Zoo Muab Kev Pabcuam Laboratory
DHCS 4504 - Tshaj Tawm Txog Kev Tshaj Tawm
DHCS 4505 (09/07) - CCS Txoj Kev Npaj Kho Mob
DHCS 4507 (01/08) - CCS Cov Chaw Kho Mob Tshwj Xeeb Daim Ntawv Qhia Txog Hloov Kho
DHCS 4509 (09/15) - Tsim CCS/GHPP Client Service Authorization Request (SAR)
DHCS 4510 (05/13) - CMS Net Medical Therapy Program MTP Therapist Table
DHCS 4512 (05/13) - DHCS Computer Files Release/Access of MC Program Confidential Oath
DHCS 4516 (09/15) - CCS Client Dental and Orthodontic Service Thov tso cai
DHCS 4582 (02/08) - Kev Sib Txuas Lus Disorder Center Application
Rov qab mus rau Forms Index
Hnub hloov tshiab kawg: 3/3/2026 8:45 AM
