Daim Ntawv Qhia Txog Kev Tiv Thaiv Kab Mob California Hearing Conservation
Vim tias qhov ntim ntawm cov ntaub ntawv tau txais ntau, koj yuav tsis tau txais kev pom zoo ntawm daim ntawv tshaj tawm tau txais. Thov siv Daim Ntawv Kev Tiv Thaiv Kev Mloog Lus (HCP) nkaus xwb. Rau email, fax lossis xa ntawv cov lus qhia, thov mus saib cov lus qhia xa ntawv hauv qab no.
To view or save forms to your computer, you must have Adobe Acrobat. If you do not have Adobe Acrobat Reader, the latest version of Acrobat Reader is available free for downloading at Adobe’s Website (Not DHCS).
HCP FORMS — Thov siv lub Xeev HCP cov ntawv hauv qab no nkaus xwb
- Daim Ntawv Qhia Txhua Xyoo Txog Kev Ntsuas Kev Hnov Lus PM 100 (pdf)
Daim ntawv no yuav raug xa email, faxed lossis xa mus rau HCP.
Thov saib cov lus qhia ntawm hauv qab no. - Daim Ntawv Thov Zam Kev Tshuaj Xyuas Kev Hnov Lus PM 359 (pdf)
Thov Nco Ntsoov: Daim ntawv no yuav raug xa email, faxed lossis xa mus rau HCP.
Thov saib cov lus qhia ntawm hauv qab no. - Daim Ntawv Thov Rau Kev Sau Npe Ua Tus Kws Kho Mob Pob Ntseg Hauv Tsev Kawm Ntawv DHCS 101 (pdf)
** Thov Nco Ntsoov: Daim ntawv no muaj cov ntaub ntawv zais cia thiab/lossis xav tau kos npe thawj.
Daim ntawv no yuav tsum tau xa mus rau qhov chaw nyob ntawm
HCP uas teev hauv qab no. - Kev Sau Npe ntawm Lub Chaw Haujlwm Uas Xav Muab Kev Pabcuam Kuaj Kev Hnov Lus PM 210 (pdf)
** Thov Nco Ntsoov: Daim ntawv no muaj cov ntaub ntawv zais cia thiab/lossis xav tau kos npe thawj.
Daim ntawv no yuav tsum tau xa mus rau qhov chaw nyob ntawm
HCP uas teev hauv qab no.
Yog Txuag lossis xa email rau koj daim ntawv
- The forms are PDF Forms and you must have Adobe Acrobat Reader. If you not have Adobe Acrobat Reader, the latest version is available free for downloading at Adobe’s Website (Not DHCS).
- Sau Lub Tsev Kawm Ntawv Lub Npe rau hauv daim ntawv, khaws thiab kaw daim ntawv
- Rov qhib daim foos kom paub meej tias koj cov ntaub ntawv thiab / lossis kev hloov pauv tau raug cawm
- Sau koj cov ntaub ntawv rau hauv daim ntawv
- Txuag thiab kaw daim ntawv
- Ua ntej xa email rau daim ntawv, xyuas daim ntawv kom paub meej tias tag nrho koj cov ntaub ntawv tau raug cawm
- Email daim foos mus rau HCP email chaw nyob hauv qab no
- Thov tsuas yog siv cov ntawv HCP uas muab rau hauv lub vev xaib no
- Thov nco ntsoov: Tsuas yog PM 100 thiab PM 359 Cov Ntawv tuaj yeem xa email lossis faxed. Tag nrho lwm cov ntaub ntawv uas yuav tsum tau kos npe thawj zaug thiab / lossis muaj cov ntaub ntawv tsis pub lwm tus paub yuav tsum xa mus rau qhov chaw nyob hauv qab no.
Cov lus qhia xa ntawv
- Email: hearingconservationprogram@dhcs.ca.gov Thov nco ntsoov: Tsuas yog PM 100 thiab/lossis PM 359 Daim Ntawv Thov tuaj yeem xa email, fax lossis xa ntawv. Tag nrho lwm daim ntawv yuav tsum tau kos npe thawj zaug thiab/lossis muaj cov ntaub ntawv tsis pub lwm tus paub thiab yuav tsum xa mus rau HCP chaw nyob hauv qab no.
- Fax: (916) 323-5316 – Please Note: Only the PM 100 and/or PM 359 Forms may be emailed, faxed or mailed. All other forms require original signature and/or contain confidential information and must be mailed to the HCP address listed below.
- Xa ntawv: ** Txhua daim ntawv tuaj yeem xa mus rau HCP chaw nyob hauv qab no.
Kev Pab Cuam Tiv Thaiv Kev Hnov Lus
Cov Kev Pab Kho Mob Rau Menyuam
Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv
PO Lub thawv xa ntawv 997413, MS 8102
Sacramento, CA 95899-7413