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

DHCS Forms: Hmong​​ 

• DHCS 0001 (01/08) (Hmo) - Cov Neeg Qhab Asmeskas 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) (Hmo) - Cov Ntaub Ntawv Pov Thawj ntawm Kev Ua Neeg Xam Xaj thiab Kev Qhia Txog Tus Kheej - Cov Kev Cai Tshiab rau cov neeg tau txais txiaj ntsig Medi-Cal uas yog neeg xam xaj Asmeskas lossis haiv neeg​​ 
  
• DHCS 0005 (02/08) (Hmo) - Cov ntaub ntawv tau txais kev ua pej xeem lossis cov ntaub ntawv qhia txog tus kheej​​ 
• DHCS 0007 (12/07) (Hmo) - Cov ntaub ntawv lees paub yog pej xeem thiab tus kheej​​ 
  
• DHCS 0008 (01/08) (Hmo) - 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) (Hmo) - Daim ntawv pov thawj ntawm tus kheej rau US Citizen lossis National Children Under 18​​ 
• DHCS 0011 (06/08) (Hmo) - Cov ntaub ntawv pov thawj lees paub tias yog neeg xam xaj lossis tus kheej​​ 

MC Forms: Hmoob​​ 

• MC 0021 (04/07) (Hmo) - Medi-Cal to Healthy Families Bridging Consent Form​​ 
• MC 176 S (03/09) (Hmo) - Medi-Cal Status Report​​ 
• MC 209 (05/12) (Hmo) - Hloov pauv koj qhov kev pab cuam Medi-Cal thaum koj cev xeeb tub thiab tom qab yug me nyuam​​ 
• MC 210 PS (05/07) (Hmo) - Property Supplement​​ 
• MC 210 RV (05/11) (Hmo) - Medi-Cal Kev Txiav Txim Txhua Xyoo​​ 
• MC 219 (11/15) (Hmo) - Cov ntaub ntawv tseem ceeb rau cov neeg thov Medi-Cal​​  
• MC 223 C (06/11) (Hmo) - Cov Lus Qhia Ntxiv ntawm Cov Lus Qhia Ntxiv rau Medi-Cal Cov Neeg Thov Me Nyuam nkaus xwb - Hnub nyoog qis dua 18​​ 
• MC 223 (10/09) (Hmo) - Tus neeg thov daim ntawv qhia ntxiv txog qhov tseeb rau Medi-Cal Cov Neeg Laus Tsuas Yog​​ 
• MC 239 DRA-6 (02/10) (Hmo) - Info Notice - Unable to Verify United States (US) Citizenship/Identity through the Social Security Administration​​ 
• MC 264 (09/11) (Hmo) - Presumptive Eligibility for Pregnant Women Program Patient Fact Sheet​​ 
• MC 371 (06/09) (Hmo) - Tsev Neeg Ntxiv Thov Medi-Cal​​ 
• MC 372 (12/21) (Hmo) - Qhov Kev Pabcuam Kev Kho Mob Lub Cev thiab Cervical Cancer (BCCTP) Flyer​​ 
• MC 4035 (04/08) (Hmo) - Medi-Cal Consent Form​​ 
  

•  MC Cov Ntaub Ntawv Ceeb Toom 003 (05/13) (Hmo) - Kev tshuaj ntsuam xyuas ntxov thiab lub caij nyoog, kuaj mob, thiab kev kho mob​​