ແບບຟອມ MC 00 ຂອງພະແນກການມີສິດໄດ້ຮັບ Medi-Cal
ກັບໄປຫາ MCED Forms ຫນ້າຫຼັກMedi-Cal Eligibility Division (MCED) ແມ່ນມີລາຍຊື່ຕາມຕົວອັກສອນຢູ່ລຸ່ມນີ້ຕາມເລກຟອມ ແລະອາດຈະລວມເອົາພາສາສະຫຼັບຖ້າມີ. ແບບຟອມຕື່ມຂໍ້ມູນ PDF ແລະພິມອາດຈະສໍາເລັດອອນໄລນ໌ແລະພິມອອກເປັນ hardcopy ເພື່ອເຊັນແລະສົ່ງໃນໄປສະນີຫຼືສົ່ງດ້ວຍຕົນເອງກັບພະນັກງານທີ່ມີສິດໄດ້ຮັບການດໍາເນີນການ.
MC 00 Forms:
- MC 05 (07/15) – Military Verification and Referral Form
- MC 13 (12/09) – Statement of Citizenship, Alienage, and Immigration Status
- MC 14 A (07/22) – Qualified Low-Income Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individuals(QI) Application
- Alt: Arabic, Armenian, Cambodian, Chinese, Farsi, Hindi, Hmong, Japanese , Korean, Laotian , Mien, Punjabi, Russian, Spanish, Tagalog, Thai , Ukrainian, Vietnamese
- ເພີ່ມເຕີມ: ລາຍຊື່ຄາວຕີ້
- MC 18 (06/07) – Important Notice About Your Medi-Cal Benefits (Eng/Sp)
- MC 19 (08/17) – Important Information for New Supplemental Security Income/State Supplementary Payment (SSI/SSP) Recipients
- MC 19A (07/17) – Important Information for SSI/SSP Applicants Medi-Cal May Help Pay Past Medical and Dental Bills (“Retroactive Coverage”)
- MC 61 (05/07) – Medical Report