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

Medi-Cal Daim Ntawv Qhia Txog Kev Tsim Nyog Muaj Peev Xwm muaj npe hauv qab no, nyob rau hauv cov tsiaj ntawv, los ntawm daim ntawv naj npawb thiab tau muab txhais ua lus Mev​​ 

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.​​  

DHCS Forms: Spanish​​ 

• DHCS 0001 (07/09) (Sp) - 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) (Sp) - 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) (Sp) - Tau Txais Kev Ua Neeg Xam Xaj lossis Cov Ntaub Ntawv Qhia Txog Tus Kheej​​ 
  
• DHCS 0007 (12/07) (Sp) - Cov ntaub ntawv lees paub ua pej xeem thiab tus kheej​​ 
• DHCS 0008 (01/08) (Sp) - 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) (Sp) - Daim ntawv pov thawj ntawm tus kheej rau US Citizen lossis National Children Under 18​​ 
• DHCS 0011 (06/08) (Sp) - Cov ntaub ntawv pov thawj ntawm Kev Ua Neeg Xam Xaj lossis Cov Ntaub Ntawv Pov Thawj​​ 
• DHCS 7068 (07/07) (Sp) - Lub luag haujlwm ntawm Public Guardians/Conservators los yog Applicant/Beneficiary Representatives​​ 
• DHCS 7077 (01/25) (Sp) - Daim Ntawv Ceeb Toom Txog Cov Qauv rau Kev Tsim Nyog Medi-Cal​​ 
• DHCS 7077 A (07/07) (Eng/Sp) - Daim Ntawv Ceeb Toom Txog Kev Hloov Ib Lub Tsev rau Ob Tus Neeg Yuav Tsum Muaj thiab Tsis Tau Yuav Tus Neeg Thov Kev Pab/Tus Neeg Tau Txais​​ 
• DHCS 7096 (07/07) (Sp) - Department of Developmental Services Waiver Referral​​ 
• DHCS 7102 (05/24) (Sp) - Daim Ntawv Ceeb Toom Txog Cov Qauv rau Medi-Cal Kev Tsim Nyog Rau Kev Tshaj Tawm los ntawm Cov Nyiaj Pov Hwm, Cov Neeg Sawv Cev, thiab Cov Lag Luam​​ 

MC Forms: Spanish​​  

• MC 0021 (04/07) (Sp) - Medi-Cal rau Healthy Families Bridging Consent Form​​ 
• MC 14 A (09/11) (Sp) - Tsim nyog tau txais cov nyiaj tau los tsawg Medicare, tus neeg tau txais txiaj ntsig Medicare tau nyiaj tsawg, thiab Daim Ntawv Thov Kev Tsim Nyog​​ 
• County Listing (Sp)​​  
• MC 18 (07/07) (Eng/Sp) - Daim Ntawv Ceeb Toom Tseem Ceeb Txog Koj Cov Nyiaj Pab Medi-Cal​​ 
• MC 174 (05/07) (Eng/Sp) - Medi-Cal Daim Ntawv Ceeb Toom rau Cov Kws Kho Mob - Kev Qhia Txog Kev Ua Haujlwm​​ 
• MC 176 PA-A (01/09) (Sp) - Medi-Cal Kev Ntsuam Xyuas Cov Khoom​​ 
• MC 176 PA-1/PA-2 (05/07) (Sp) - Daim Ntawv Qhia Txog Khoom Muag / Kev Ntsuas rau Cov Poj Niam Hauv Tsev​​ 
• MC 176 S (03/09) (Sp) - Medi-Cal Status Report​​ 
• MC 176 TMC (10/08) (Sp) - Transitional Medi-Cal (TMC) Quarterly Status Report​​ 
• MC 179 (01/08) (Sp) - Daim Ntawv Ntsuam Xyuas Kev Tsis Taus​​ 
• MC 209 (05/12) (Sp) - Hloov pauv koj qhov kev pab cuam Medi-Cal thaum koj cev xeeb tub thiab tom qab koj yug menyuam​​ 
• MC 210 A (09/07) (Sp) - Ntxiv rau Cov Lus Qhia Txog Qhov Tseeb rau Kev Pabcuam Rov Qab/Kev Kho Kom Zoo Dua​​ 
• MC 210 B (08/01) (Sp) - Ntxiv rau Cov Lus Qhia Txog Qhov Tseeb​​  
• MC 210 PA (05/07) (Sp) - Nqe lus piav qhia txog Cov Khoom Muaj Tseeb​​ 
• MC 210 PS (05/07) (Sp) - Khoom Ntxiv​​ 
• MC 210 RV (05/11) (Sp) - Medi-Cal Kev Txiav Txim Txhua Xyoo​​ 
• MC 210 SC (05/07) (Sp) - Cov Me Nyuam Ntxiv​​ 
• MC 210 SE (05/07) (Sp) - Cov Nqi Kawm Ntawv Kawm Ntawv​​ 
• MC 210 SI - (09/08) (Sp) - Cov Nyiaj Tau Los Hauv Hom / Kev Txheeb Xyuas Vaj Tsev​​  
• MC 210 SW (07/07) (Sp) - Keeb Kwm Kev Ua Haujlwm thiab Kev Ua Haujlwm​​ 
• MC 212 (07/07) (Sp) - Medi-Cal Residency Declaration​​ 
• MC 214 (07/07) (Sp) - Cov Ntaub Ntawv Tseem Ceeb Txog Chaw Nyob​​ 
• MC 215 (10/07) (Sp) - Thov kom rho tawm thiab/lossis zam daim ntawv ceeb toom ua ntej kaum-hnub​​ 
• MC 219 (11/15) (Sp) - Cov ntaub ntawv tseem ceeb rau cov neeg thov Medi-Cal​​ 
• MC 220 8pt (06/08) (Sp) - Tso cai tso tawm cov ntaub ntawv - 8 point print​​ 
• MC 220 14pt (04/08) (Sp) - Tso cai tso tawm cov ntaub ntawv - 14 point print​​ 
• MC 223 C (06/11) (Sp) - Cov Lus Qhia Ntxiv ntawm Cov Lus Qhia Ntxiv rau Medi-Cal Cov Neeg Thov Me Nyuam nkaus xwb - Hnub nyoog qis dua 18 xyoo​​ 
• MC 223 (10/09) (Sp) - Tus neeg thov daim ntawv qhia ntxiv txog qhov tseeb rau Medi-Cal Cov Neeg Laus Tsuas Yog​​ 
• MC 239 DRA-6 (02/10) (Sp) - Cov Ntaub Ntawv Ceeb Toom - Tsis Muaj Peev Xwm Txheeb Xyuas Tebchaws Meskas (Asmeskas) Kev Xam Xaj / Tus Kheej Los Ntawm Lub Chaw Saib Xyuas Kev Nyab Xeeb​​ 
• MC 250 A (12/14) (Sp) - Daim Ntawv Thov thiab Nqe Lus Qhia Txog Qhov Tseeb Rau Ib Tug Neeg Muaj hnub nyoog 18 xyoos thiab qis dua 21 xyoos thiab leej twg nyob hauv Kev Pabcuam Kev Khomob rau Nws Hnub yug 18th​​ 
• MC 262 (06/07) (Sp) - Kev txiav txim rov qab rau Medi-Cal Cov neeg tau txais txiaj ntsig (Kev Saib Xyuas Ntev Ntev hauv Tus Kheej MFBU)​​ 
• MC 263 SR (02/09) (Sp) - Nqe Lus Qhia ntawm California Residency​​ 
• MC 264 (09/11) (Sp) - Presumptive Eligibility for Pregnant Women Program Patient Fact Sheet​​ 
• MC 265 (06/07) (Sp) - Cov Lus Qhia Tus Neeg Mob rau Daim Ntawv Thov Kev Tsim Nyog​​ 
• MC 267 (05/08) (Sp) - Kev piav qhia ntawm Kev Tsim Nyog Rau Kev Tsim Nyog Tsim Nyog​​ 
• MC 273 (05/07) (Sp) - Daim Ntawv Qhia Txog Kev Ua Haujlwm​​ 
• MC 274 TB (05/07) (Sp) - Medi-Cal Tuberculosis Program Application​​ 
• MC 306 (01/08) (Sp) - Teem Tus Neeg Sawv Cev​​ 
• MC 322 (09/07) (Sp) - Khoom ntiag tug thiab tus kheej - Ntxiv rau Medi-Cal Mail-In Application​​ 
• MC 330 (10/24) (Sp) - Kev Xa Mus Rau Me Nyuam Tshiab (Tsis yog Daim Ntawv Thov rau Medi-Cal)​​ 
  
• MC 338 Flyer (05/07) (Sp) - Medi-Cal Kev Pabcuam rau Cov Neeg Ua Haujlwm Tsis Muaj Peev Xwm 250 feem pua Kev Pabcuam Ua Haujlwm Tsis Taus​​ 
• MC 354 (05/07) (Sp) - Medi-Cal Hu rau Hloov Kho Tshiab​​ 
• MC 355 (06/08) (Sp) - Medi-Cal Thov Qhia Txog Cov Ntaub Ntawv​​ 
• MC 356 (05/07) (Sp) - "Safe Arms for Newborn" Cov Lus Nug Txog Kev Kho Mob​​ 
• MC 368 A (11/10) (Sp) - Cov ntaub ntawv tseem ceeb rau cov neeg thov Medi-Cal​​ 
• MC 368 M (06/07) (Sp) - Daim Ntawv Qhia Ntxiv rau Cov Neeg Thov Npe Nkag Siab​​ 
• MC 371 (06/09) (Sp) - Cov Tsev Neeg Ntxiv Thov Medi-Cal​​ 
• MC 372 (12/21) (Sp) - Qhov Kev Pabcuam Kev Kho Mob Lub mis thiab Cervical Cancer (BCCTP) Flyer​​ 
• MC 4026 (07/07) (Sp) - Thov Kev Pabcuam Kev Tsim Nyog Muaj Cai​​ 
• MC 4035 (04/08) (Sp) - Medi-Cal Daim Ntawv Pom Zoo​​ 

MC Cov Ntawv Ceeb Toom: Lus Mev​​ 

• MC Cov Ntaub Ntawv Ceeb Toom 002 (09/07) (Sp) - Summary Medi-Cal Kev Tsim Nyog (2.18MB)​​ 
• MC Cov Ntaub Ntawv Ceeb Toom 003 (11/12) (Sp) - Kev tshuaj ntsuam xyuas ntxov thiab lub caij nyoog, kuaj mob, thiab kev kho mob​​ 
• MC Cov Ntaub Ntawv Ceeb Toom 004 (05/07) (Sp) - Cov Ntaub Ntawv Tseem Ceeb rau Medi-Cal Nursing Home Patients​​ 
• MC Cov Ntaub Ntawv Ceeb Toom 007 (11/22) (Sp) - Medi-Cal General Property Limitations​​ 
• MC Cov Ntaub Ntawv Ceeb Toom 008 (10/11) (Sp) - Qhov Kev Pabcuam Tsim Nyog Medicare​​ 
• MC Cov Ntaub Ntawv Ceeb Toom 010 (01/09) (Sp) - Tus Neeg Ua Haujlwm Tsis Muaj Peev Xwm Tsim Nyog​​ 
• MC Cov Ntaub Ntawv Ceeb Toom 013 (05/07) (Sp) - Cov Ntaub Ntawv Tseem Ceeb Hais Txog Koj Cov Cai Thov Thov​​ 
• MC Cov Ntaub Ntawv Ceeb Toom 017 (07/07) (Sp) - Yam Koj Yuav Tsum Paub Txog Koj Daim Ntawv Thov Medi-Cal Disability​​