Medi-Cal Eligibility Division MC 200 Daim Ntawv Thov
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Medi-Cal Eligibility Division (MCED) cov ntaub ntawv muaj nyob rau hauv cov tsiaj ntawv hauv qab no los ntawm tus lej daim ntawv thiab tej zaum yuav muaj lwm hom lus yog muaj. PDF sau thiab luam cov ntawv tuaj yeem ua tiav hauv online thiab luam tawm rau cov ntawv tawv tawv kom kos npe thiab xa hauv lossis xa tuaj rau tus neeg ua haujlwm tsim nyog rau kev ua haujlwm.
Hloov tshiab!
Txhua daim foos Presumptive Eligibility rau Cov Poj Niam Cev Xeeb Tub yuav tam sim no muaj nyob rau ntawm peb lub vev xaib tus kws kho mob rau daim ntawv hauv qab no:
MC 263-SR, MC 264, MC 265, MC 266, MC 267, MC 283, MC 285, & MC 286
MC 200 Daim Ntawv Thov:
- MC 209 (05/12) - Hloov pauv rau koj qhov kev pab cuam Medi-Cal thaum koj cev xeeb tub thiab tom qab koj yug menyuam
- MC 210 A (09/07) - Ntxiv rau Daim Ntawv Qhia Txog Qhov Tseeb rau Kev Pabcuam Rov Qab/Kev Kho Kom Zoo Dua
- MC 210 B (05/07) - Ntxiv rau Cov Lus Qhia Txog Qhov Tseeb (PICKLE Kev Tsim Nyog / Kev Txiav Txim)
- MC 210 PA (05/07) - Kev Ntsuam Xyuas Cov Lus Qhia ntawm Qhov Tseeb
- MC 210 RV (10/20) - Medi-Cal Kev Txiav Txim Txhua Xyoo
- Alt: Arabic , Armenian , Cambodia, Suav , Farsi, Hindi, Hmoob, Nyiv , Kauslim , Laotian , Mien , Punjabi, Lavxias , Spanish , Tagalog , Thaib , Ukrainian , Nyab Laj
- MC 210 SC (05/07) - Cov Me Nyuam Ntxiv (Ntxiv rau Medi-Cal Daim Ntawv Qhia Txog Qhov Tseeb, MC 210) (Eng/Sp)
- MC 210 SE (05/07) - Cov Nqi Kawm Ntawv rau Tub Kawm Ntawv (Ntxiv rau Medi-Cal Nqe Lus Qhia Txog Qhov Tseeb, MC 210)
- MC 210 SI (09/08) - Cov Nyiaj Tau Los Hauv Hom / Kev Tshawb Fawb Hauv Tsev (Ntxiv rau MC 210 Nqe Lus Qhia Txog Qhov Tseeb) (Eng/Sp)
- MC 210 SW (05/07) - Keeb Kwm Kev Ua Haujlwm thiab Kev Ua Haujlwm
- MC 212 (05/07) - Medi-Cal Residency Declaration (Eng/Sp)
- MC 214 (05/07) - Cov Ntaub Ntawv Tseem Ceeb Txog Chaw Nyob
- MC 215 (05/07) - Thov kom rho tawm thiab/lossis zam daim ntawv ceeb toom ua ntej kaum-hnub
- MC 216 (10/20) - Daim Ntawv Rov Ntxiv Ua Ntej Ua Ntej
- Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thaib, Ukrainian, Nyab Laj
- MC 217 (10/20) - Daim Ntawv Rov Ntxiv Ua Ntej Ua Ntej
- Alt: Arabic, Armenian, Cambodian, Suav, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thai, Ukrainian, Nyab Laj
- MC 219 (11/15) - Cov ntaub ntawv tseem ceeb rau cov neeg thov Medi-Cal (Loj Print, Eng)
- Alt: Arabic, Armenian, Suav, Farsi, Hmong, Cambodian, Korean, Russian, Spanish, Tagalog, Nyab Laj
- MC 220 8pt (06/08) - Tso cai rau kev tso lus muab tawm
- MC 220 14pt (04/08) - Kev tso cai tso tawm cov ntaub ntawv (Cov Ntawv Loj)
- MC 221 LA (02/14) - Kev Txiav Txim Tsis Taus thiab Kev Xa Mus Los (Los Angeles)
- MC 222 LA (02/14) - DDSD Pending Information Update (Los Angeles)
- MC 223 (10/09) - Tus Neeg Thov Kev Pab Cov Lus Qhia Ntxiv Txog Qhov Tseeb rau Medi-Cal
- Alt: Arabic, Armenian, Suav, Farsi, Hmong, Cambodian, Korean, Russian, Spanish, Tagalog, Nyab Laj
- MC 223 C (06/11) - Cov Lus Qhia Ntxiv ntawm Qhov Tseeb rau Medi-Cal Cov Neeg Thov Me Nyuam nkaus xwb- Hnub nyoog qis dua 18 (MC 223C) Cov lus qhia
- Alt: Arabic, Armenian, Suav, Farsi, Hmong, Cambodian, Korean, Russian, Spanish, Tagalog, Nyab Laj
- MC 224 A (06/07) - Medi-Cal Muaj Peev Xwm Muaj Peev Xwm Them Nyiaj Tshaj Tawm Tshaj Qhia Txog Cov Nyiaj Tau Los Ua Haujlwm lossis Lwm Qhov Kev Pab Kho Mob
- MC 224 AS (05/07) - Ntxiv Medi-Cal Muaj Peev Xwm Muaj Peev Xwm Them Nyiaj Tshaj Qhia Tshaj Tawm Txog Cov Nyiaj Tau Los Ua Haujlwm lossis Lwm Qhov Kev Pab Kho Mob
- MC 224 B (06/07) - Medi-Cal Daim Ntawv Qhia Txog Kev Them Nyiaj Tshaj Tawm - Cov Khoom Tag Nrho Kev Tsim Nyog lossis Kev Tsim Nyog Rau Ib Qib Tshwj Xeeb ntawm Kev Pabcuam
- MC 224 BS (05/07) - Ntxiv Medi-Cal Muaj Peev Xwm Tshaj Tawm Tshaj Tawm Txog Kev them nyiaj ntau dhau - Cov Khoom Tag Nrho Kev Tsim Nyog lossis Kev Tsim Nyog Rau Ib Qib Tshwj Xeeb ntawm Kev Pabcuam
- MC 239 DRA-6 (02/10) - Daim Ntawv Ceeb Toom Cov Ntaub Ntawv - Tsis Muaj Peev Xwm Txheeb Xyuas Tebchaws Meskas (US) Citizenship/Identity Los Ntawm Lub Chaw Tswj Xyuas Kev Nyab Xeeb
- Alt: Arabic, Armenian, Suav, Farsi, Hmong, Cambodian, Korean, Russian, Spanish, Tagalog, Nyab Laj
- MC 250 (05/07) - Daim Ntawv Thov thiab Nqe Lus Qhia Txog Qhov Tseeb rau Me Nyuam Tsis Nyob Nrog Niam Txiv lossis Tus txheeb ze thiab rau leej twg Lub Chaw Haujlwm Saib Xyuas Pej Xeem tau txais qee lub luag haujlwm nyiaj txiag
- MC 250 A (12/14) - Daim Ntawv Thov Kev Pabcuam Medi-Cal rau Cov Hluas Cov Hluas
