Medi-Cal Kev Tsim Nyog Kev Tsim Nyog Division Translated Forms: Suav​​ 

Rov qab mus rau Phau Ntawv Txhais Lus Lub Ntsiab​​ 

DHCS Forms: Suav​​  

• DHCS 0001 (01/08) (Chi) - Cov Neeg Asmeskas Cov Neeg Xam Xaj thiab Cov Neeg Qhab Asmeskas uas thov Medi-Cal Yuav tsum Qhia Cov Ntaub Ntawv Pov Thawj ntawm Neeg Xam Xaj thiab Tus Kheej​​ 
• DHCS 0002 (01/08) (Chi) - Cov Ntaub Ntawv Pov Thawj ntawm Kev Ua Neeg Xam Xaj thiab Kev Qhia Txog Tus Kheej - Cov Lus Qhia Tshiab rau cov neeg tau txais txiaj ntsig Medi-Cal uas yog neeg xam xaj Asmeskas lossis haiv neeg​​ 
  
• DHCS 0005 (02/08) (Chi) - Tau txais cov ntaub ntawv pov thawj ntawm pej xeem los yog tus kheej​​ 
• DHCS 0007 (12/07) (Chi) - Cov ntaub ntawv lees paub ua pej xeem thiab tus kheej​​ 
  
• DHCS 0008 (01/08) (Chi) - Cov ntaub ntawv pov thawj ntawm Kev Ua Neeg Xam Xaj thiab Kev Qhia Txog Tus Kheej--Rau Cov Menyuam Yaus uas yog Neeg Xam Xaj Meskas lossis Neeg Qhab Asmeskas ua daim ntawv thov Kev Noj Qab Haus Huv / Medi-Cal Joint Application​​ 
• DHCS 0009 (09/07) (Chi) - Daim ntawv pov thawj ntawm tus kheej rau US Citizen lossis National Children Under 18​​ 
• DHCS 0011 (06/08) (Chi) - Cov ntaub ntawv pov thawj lees paub tias yog neeg xam xaj lossis cov ntaub ntawv qhia txog tus kheej​​ 

MC Forms: Suav​​ 

• MC 0021 (04/07) (Chi) - Medi-Cal rau Healthy Families Bridging Consent Form​​ 
• MC 176 S (03/09) (Chi) - Medi-Cal Status Report​​ 
• MC 209 (05/12) (Chi) - Kev hloov pauv rau koj qhov kev pab cuam Medi-Cal thaum koj cev xeeb tub thiab tom qab koj yug menyuam​​ 
• MC 210 RV (05/11) (Chi) - Medi-Cal Kev Txiav Txim Txhua Xyoo​​ 
• MC 210 PS (01/09) (Chi) - Khoom Ntxiv​​ 
• MC 219 (11/15) (Chi) - Cov ntaub ntawv tseem ceeb rau cov neeg thov Medi-Cal​​ 
• MC 223 C (06/11) (Chi) - Cov Lus Qhia Ntxiv ntawm Cov Lus Qhia Ntxiv rau Medi-Cal Cov Neeg Thov Me Nyuam Tsuas - Hnub nyoog qis dua 18​​ 
• MC 223 (10/09) (Chi) - Tus neeg thov daim ntawv qhia ntxiv txog qhov tseeb rau Medi-Cal Cov Neeg Laus Tsuas Yog​​ 
• MC 239 DRA-6 (02/10) (Chi) - Cov Ntaub Ntawv Ceeb Toom - Tsis Muaj Peev Xwm Txheeb Xyuas Tebchaws Meskas (US) Kev Xam Xaj / Tus Kheej Los Ntawm Lub Chaw Tswj Xyuas Kev Nyab Xeeb​​ 
• MC 264 (09/11) (Chi) - Kev Tsim Nyog Kev Tsim Nyog rau Cov Poj Niam Cev Xeeb Tub Txoj Haujlwm Pabcuam Tus Neeg Mob​​ 
• MC 371 (06/09) (Chi) - Cov Tsev Neeg Ntxiv Thov Medi-Cal​​ 
• MC 372 (12/21) (Chi) - Qhov Kev Pabcuam Kev Kho Mob Lub Cev thiab Cervical (BCCTP) Flyer​​ 
  
• MC 4035 (04/08) (Chi) - Medi-Cal Daim Ntawv Pom Zoo​​ 

MC Cov Ntaub Ntawv Ceeb Toom: Suav​​ 

• MC Cov Ntaub Ntawv Ceeb Toom 003 (05/13) (CHI) - Kev Tshuaj Ntsuam Xyuas Thaum Ntxov thiab Lub Sij Hawm, Kev Ntsuas, thiab Kev Kho Mob​​