Medi-Cal Kev Tsim Nyog Kev Tsim Nyog Division Translated Forms: Nyab Laj​​ 

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

Medi-Cal Eligibility Division (MCED) cov ntaub ntawv tau teev tseg hauv qab no, cov tsiaj ntawv, los ntawm tus lej thiab tau muab txhais ua lus Nyab Laj.​​  

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: Nyab Laj​​ 

• DHCS 0001 (01/08) (Vie) - Cov Neeg Asmeskas Cov Neeg Xam Xaj thiab Cov Neeg Qhab Asmeskas uas thov Medi-Cal Yuav tsum muaj pov thawj ntawm pej xeem thiab tus kheej​​ 
• DHCS 0002 (01/08) (Vie) - Cov Ntaub Ntawv Pov Thawj ntawm Kev Xam Xaj thiab Kev Qhia Txog Tus Kheej--Cov Kev Cai Tshiab rau Cov Neeg Tau Txais Kev Pab Medi-Cal uas yog neeg xam xaj Asmeskas lossis haiv neeg​​ 
• DHCS 0005 (02/08) (Vie) - Cov ntaub ntawv tau txais kev ua pej xeem lossis cov ntaub ntawv qhia txog tus kheej​​ 
  
• DHCS 0007 (12/07) (Vie) - Cov ntaub ntawv lees paub ua pej xeem thiab tus kheej​​ 
• DHCS 0008 (01/08) (Vie) - Cov ntaub ntawv pov thawj ntawm kev ua pej xeem thiab kev qhia txog tus kheej rau cov menyuam yaus uas yog neeg xam xaj Asmeskas lossis haiv neeg ua tiav Cov Tsev Neeg Noj Qab Haus Huv​​ 
• DHCS 0009 (09/07) (Vie) - Daim ntawv pov thawj ntawm tus kheej rau US Citizen lossis National Children Under 18​​ 
• DHCS 0011 (06/08) (Vie) - Cov ntaub ntawv pov thawj ntawm kev ua neeg pej xeem lossis tus kheej​​ 

MC Forms: Nyab Laj​​ 

• MC 0021 (04/07) (Vie) - Medi-Cal rau Healthy Families Bridging Consent Form​​ 
• MC 176 S (03/09) (Vie) - Medi-Cal Status Report​​ 
• MC 209 (05/12) (Vie) - 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) (Vie) - Medi-Cal Kev Txiav Txim Txhua Xyoo​​ 
• MC 219 (11/15) (Vie) - Cov ntaub ntawv tseem ceeb rau cov neeg thov Medi-Cal​​ 
• MC 223 C (06/11) (Vie) - 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) (Vie) - Tus neeg thov daim ntawv qhia ntxiv ntawm qhov tseeb rau Medi-Cal Cov Neeg Laus Tsuas Yog​​ 
• MC 239 DRA-6 (02/10) (Vie) - Daim 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 264 (09/11) (Vie) - Kev Tsim Nyog Kev Tsim Nyog rau Cov Poj Niam Cev Xeeb Tub Txoj Haujlwm Pabcuam Tus Neeg Mob​​ 
• MC 371 (06/09) (Vie) - Cov Tsev Neeg Ntxiv Thov Medi-Cal​​ 
• MC 372 (12/21) (Vie) - Qhov Kev Pabcuam Kev Kho Mob Lub mis thiab Cervical (BCCTP) Flyer​​ 
• MC 4035 (04/08) (Vie) - Medi-Cal Daim Ntawv Pom Zoo​​ 

MC Cov Ntaub Ntawv Ceeb Toom: Nyab Laj​​ 

• MC Cov Ntaub Ntawv Ceeb Toom 003 (05/13) (Vie) - Kev tshuaj xyuas ntxov thiab sij hawm ntev, kuaj mob, thiab kev pab kho mob​​