ພະແນກການມີສິດໄດ້ຮັບ Medi-Cal ແບບຟອມແປ: ພາສາເກົາຫຼີ
ແບບຟອມຂອງພະແນກການມີສິດໄດ້ຮັບ Medi-Cal (MCED) ມີລາຍຊື່ຂ້າງລຸ່ມນີ້, ຕາມຕົວອັກສອນ, ຕາມຕົວເລກແບບຟອມ ແລະໄດ້ຖືກແປເປັນພາສາເກົາຫຼີ.
ແບບຟອມຕື່ມຂໍ້ມູນ PDF ແລະພິມອາດຈະສໍາເລັດອອນໄລນ໌ແລະພິມອອກເປັນ hardcopy ເພື່ອເຊັນແລະສົ່ງໃນໄປສະນີຫຼືສົ່ງດ້ວຍຕົນເອງກັບພະນັກງານທີ່ມີສິດໄດ້ຮັບການດໍາເນີນການ.
ແບບຟອມ DHCS: ພາສາເກົາຫຼີ
- DHCS 0001 (01/08) (Kor) – U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity
- DHCS 0002 (01/08) (Kor) – Proof of Citizenship and Identity–New Requirements for Medi-Cal Beneficiaries Who Are U.S. Citizens or Nationals
- DHCS 0005 (02/08) (Kor) – Receipt of Citizenship or Identity Documents
- DHCS 0007 (12/07) (Kor) – Acceptable Citizenship and Identity Documents
- DHCS 0008 (01/08) (Kor) – Proof of Citizenship and Identity Requirements for Children Who Are U.S. Citizens or Nationals Filling Out the Healthy Families
- DHCS 0009 (09/07) (Kor) – Affidavit of Identity for U.S. Citizen or National Children Under 18
- DHCS 0011 (06/08) (Kor) – Proof of Acceptable Citizenship or Identity Documents
ແບບຟອມ MC: ພາສາເກົາຫຼີ
- MC 0021 (04/07) (Kor) – Medi-Cal to Healthy Families Bridging Consent Form
- MC 176 S (03/09) (Kor) – Medi-Cal Status Report
- MC 209 (05/12) (Kor) – Changes to your Medi-Cal coverage during your pregnancy and after you give birth
- MC 210 RV (05/11)(Kor) – Medi-Cal Annual Redetermination
- MC 219 (11/15) (Kor) – Important Information for Persons Requesting Medi-Cal
- MC 223 C (06/11) (Kor) – Supplemental Statement of Facts for Medi-Cal Child Applicant Only – Under Age 18
- MC 223 (10/09) (Kor) – Applicant’s supplemental statement of facts for Medi-Cal Adult Applicant Only
ແຈ້ງການຂໍ້ມູນຂ່າວສານ MC: ພາສາເກົາຫຼີ
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MC Information Notice 003 (05/13) (Kor) – Early and Periodic Screening, Diagnosis, and Treatment Services