ກັບໄປທີ່ໜ້າຫຼັກແບບຟອມ MCED

ແບບຟອມຂອງພະແນກການມີສິດໄດ້ຮັບ Medi-Cal (MCED) ແມ່ນມີລາຍຊື່ຕາມຕົວອັກສອນຂ້າງລຸ່ມນີ້ຕາມຕົວເລກແບບຟອມ ແລະອາດຮວມມີພາສາສຳຮອງ ຖ້າມີ. ແບບຟອມຕື່ມຂໍ້ມູນ PDF ແລະພິມອາດຈະສໍາເລັດອອນໄລນ໌ແລະພິມອອກເປັນ hardcopy ເພື່ອລົງນາມແລະສົ່ງໃນໄປສະນີຫຼືສົ່ງດ້ວຍຕົນເອງກັບພະນັກງານທີ່ມີສິດໄດ້ຮັບການດໍາເນີນການ. 

ແບບຟອມ DHCS 7000:

• DHCS 7013 (06/07) – Change of Status-Liens (2.79mb)
• DHCS 7014 (06/07) – Property Lien Referral
• DHCS 7019 (05/07) – Pickle Eligibles Financial Eligibility Work Sheet—Eligible Child With Ineligible Parent or Parents 
• DHCS 7020 (06/07) – Screening Work Sheet 
• DHCS 7021 (05/07) – Financial Eligibility Work Sheet (Individual or Couple, Applicant With an Ineligible Spouse) 
  • Alt: ຄໍາແນະນໍາ 
• DHCS 7029 (06/07) – Disregard Computation Work Sheet (Pickle Eligible Individual or Couple and/or Ineligible Spouse with RSDI Income) 
• DHCS 7035 A (06/07) – Medical Report on Adult with Allegation of Human Immunodeficiency Virus (HIV) Infection 
• DHCS 7035 C (04/08) – Medical Report on Child with Allegation of Human Immunodeficiency Virus (HIV) Infection 
• DHCS 7037 (05/07) – Pickle Resource Work Sheet
• DHCS 7044 (12/08) – Statement of Living Arrangements, In-Kind Support, and Maintenance
• DHCS 7045 (05/07) – Worker Observations – Disability
• DHCS 7068 (06/07) – Responsibilities of Public Guardians/Conservators or Applicant/Beneficiary Representatives
• DHCS 7071 (06/07) – Medi-Cal Waiver Information and Authorization
• DHCS 7075 (05/07) – Pickle Needs Test
• DHCS 7077 (01/25) – Notice Regarding Standards for Medi-Cal Eligibility
  • Alt: Arabic, Armenian, ກໍາປູເຈຍ, ຈີນ, Farsi, ຮິນດູ, ມົ້ງ, ຍີ່ປຸ່ນ, ເກົາຫຼີ, Laotian, Mien, Punjabi, ລັດເຊຍ, ສະເປນ, Tagalog, ໄທ, ອູແກຣນ, ຫວຽດນາມ
• DHCS 7077 A (05/07) – Notice Regarding Transfer of a Home for both a Married and an Unmarried Applicant/Beneficiary (Eng/Sp)
• DHCS 7089 (05/07) – Screening Worksheet Disabled Widow(er) Checklist (DW) Ages 50 to 64
• DHCS 7096 (05/07) – Department of Developmental Services Waiver Referral
• DHCS 7102 (05/24) – Notice Regarding Standards for Medi-Cal Eligibility for Distribution by Insurers, Agents, and Brokers
  • Alt: Arabic, Armenian, ກໍາປູເຈຍ, ຈີນ, Farsi, ຮິນດູ, ມົ້ງ, ຍີ່ປຸ່ນ, ເກົາຫຼີ, Laotian, Mien, Punjabi, ລັດເຊຍ, ສະເປນ, Tagalog, ໄທ, ອູແກຣນ, ຫວຽດນາມ
  • Large Font:  Arabic, Armenian, Cambodian, Chinese, English, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thai, Ukrainian, Vietnamese
• DHCS 7103 (09/22) – Request for Additional Income Information
  • Alt: Arabic, Armenian, ກໍາປູເຈຍ, ຈີນ, Farsi, ຮິນ ດູ , ມົ້ງ, ຍີ່ປຸ່ນ, ເກົາຫຼີ, Laotian, Mien, Punjabi, ລັດເຊຍ, ສະເປນ, Tagalog, ໄທ, ອູແກຣນ, ຫວຽດນາມ
  • ຕົວອັກສອນໃຫຍ່:  ອາຣັບ, ອາເມເນຍ , ກຳປູເຈຍ , ຈີນ, ອັງກິດ, ຟາ ຊີ, ຮິນດູ , ມົ້ງ, ຍີ່ປຸ່ນ , ເກົາ ຫຼີ, ລາວ, ມຽນ, ປັນຈາບີ , ລັດເຊຍ , ສະເປນ, ຕາ ກາລັອກ , ໄທ , ອູແກຣນ , ຫວຽດນາມ