• “Safe Arms for Newborns” Medical Questionnaire (MC 356, 05/07)
   Alt: Spanish​​ 
• Screening Work Sheet (DHCS 7020, 06/07)​​ 
• Screening Worksheet Checklist (DW) na may kapansanan na Widow(er) Edad 50 hanggang 64 (DHCS 7089, 05/07)​​ 
• SD/MC Monthly Claim for Reimbursement – Quality Assurance/Utilization Review (QA/UR) Cost  (MC 1982 C, 07/12)​​ 
• SD/MC Quarterly Claim for Reimbursement – Administrative Cost (MC 1982 B, 07/12)
  Alt: MC 1982 B (Excel)​​   
• SD/MC Quarterly Claim for Reimbursement – Medi-Cal Administrative Activities (MAA) (MC 1982 D, 07/12)
  Alt: MC 1982 D – (Excel)​​ 
• SD/MC Quarterly Claim for Reimbursement – Treatment Cost (MC 1982 A, 07/12)​​ 
• Seksyon 1931 Form ng Badyet ng Aplikante/Tumatanggap: Para sa Pagtukoy ng Netong Di-Exempt na Kita at Seksyon 1931 na Pagkakarapat-dapat sa Kita para sa mga Aplikante; At para sa mga Recipient sa ilalim ng Alternatibong B (MC 176 MA Applicant-Recipient, 05/07)​​ 
• Form ng Badyet ng Tatanggap ng Seksyon 1931: Para sa Pagtukoy ng Netong Di-Exempt na Kita at Pagiging Karapat-dapat sa Seksyon 1931 Kita para sa Mga Tatanggap sa Ilalim ng Alternatibong A (MC 176 MA Recipient, 05/07)​​ 
• Section 1931(b) Sneede v. Kizer Net Nonexempt Income Determination and Mini Budget Unit (MBU) Determination – Applicant (MC 175-3I.2A, 05/07)​​ 
• Section 1931(b) Sneede v. Kizer Net Nonexempt Income Determination and Mini Budget Unit (MBU) Determination – Recipient (MC 175-3I.2R, 05/07)​​ 
• SGA Work Sheet (MC 272, 05/07)​​ 
• Share of Cost Determination – MFBUs Which Do Not Include LTC Persons (MC 176 M, 05/07)​​ 
• Share of Cost Determination – MFBUs with LTC Persons Included – LTC (MC 176 M-LTC, 11/07)​​ 
• Share-of-Cost Medi-Cal Provider Sulat (MC 1054, 6/07)​​ 
• Sneede v. Kizer Allocation mula sa isang SSI o IHSS Person (MC 175-6, 05/07)​​ 
• Sneede v. Kizer Allocation Work Sheet Board at Taong Pangangalaga sa Asawa at/o Mga Anak sa Tahanan o LTC Person (AFDC/MN/MI)Na Walang Asawa ng Komunidad sa mga Anak sa Tahanan (MC 175-7, 05/07)​​ 
• Mga Tanong sa Pagsusuri ng Kita ng Sneede v. Kizer (MC 175 I, 05/07)​​ 
• Sneede v. Kizer Mini Budget Units At:(MC 175-4, 05/07)​​ 
• Sneede v. Kizer Net Nonexempt Income Determination (MC 175-3I, 05/07)​​ 
• Sneede v. Kizer Net Nonexempt Income Determination-Continuation Sheet (MC 175,-31.1, 05/07)​​ 
• Sneede v. Kizer Property Screening Questions (MC 175-P, 05/07)​​ 
• Sneede v. Kizer Property Work Sheet (MC 175-3P, 05/07)​​ 
• Sneede v. Kizer Responsable Relative Determination (MC 175-2, 05/07)​​ 
• Sneede v. Kizer Section 1931(b) Property Work Sheet (MC 324, 05/07)​​ 
• Abiso sa Referral ng Social Security Administration (MC 194, 07/12)​​ 
• Application ng Sole Proprietor (DHCS 5111)​​  
• Form ng Pag-update ng Direktoryo ng CCS Special Care center  (DHCS 4507, 01/08)​​  
• SSI/SSP Income Test Work sheet For The 250 Percent Working Disabled Program – Adults (MC 338 A, 05/07)​​ 
• SSI/SSP Property Test Worksheet For The 250 Percent Working Disabled Program – Adults and Child Applicants (MC 338 C, 05/07)​​ 
• Talatanungan sa Kalusugan ng Staff (DHCS 5105)​​ 
• Statement of Citizenship, Alienage, and Immigration Status (MC 13, 12/09)​​ 
• Statement of Living Arrangements, In-Kind Support, and Maintenance (DHCS 7044, 12/08)​​ 
• Stepparent Computation (MC 176 W.1, 05/07)​​ 
• Mga Gastusin sa Edukasyon ng Mag-aaral (Supplement sa Medi-Cal Statement of Facts, MC 210) (MC 210 SE, 05/07)  
  Alt: Spanish​​ 
• Kahalili na Pananagutan sa Magkasanib at Ilang Kasunduan sa Pananagutan (DHCS 6217, 02/08)
  ​​ 
• Supplement sa Statement of Facts (Pickle Eligibility/ Determination) (MC 210 B, 05/07)
  Alt: Spanish​​ 
• Supplement sa Statement of Facts for Retroactive Coverage/Restoration (MC 210 A, 09/07)
  Alt: Spanish​​ 
• Karagdagang Kahilingan sa Aplikasyon para sa Mga Karagdagang Serbisyo (DHCS 5255)​​ 
• Supplemental Medi-Cal Potential Overpayment Reporting Work Sheet – Property Total Ineligibility or Ineligibility For A Specific level of Services (MC 224 B-S, 05/07)​​  
• Karagdagang Medi-Cal Potensyal na Pag-uulat sa Work Sheet ng Kita o Iba pang Saklaw sa Kalusugan (MC 224 AS, 05/07)​​ 
• Pamamaraan ng Karagdagang Kita sa Seguridad (SSI) Worksheet sa Pagiging Karapat-dapat sa Kita ng Pang-adulto (MC 326 A, 05/07)​​ 
• Supplemental Security Income (SSI) Methodology Income Worksheet – Eligible Child with Ineligible Parent or Parent(s) (MC 326 C, 05/07)​​ 
• Supplemental Security Income (SSI) Program Property Worksheet Pang-adulto (MC 327 A, 05/07)​​ 
• Supplemental Security Income (SSI) Program Property Worksheet Child (MC 327 C, 05/07)​​ 
• Karagdagang Pahayag ng Mga Katotohanan para sa Aplikante ng Bata sa Medi-Cal Lamang- Wala pang 18 taong gulang (MC 223C)
  Mga Tagubilin (MC 223 C, 06/11)
  Alt: Arabic, Armenian, Chinese, Farsi, Hmong, Cambodian, Korean, Russian, Spanish, Tagalog​​ 

Bumalik sa Forms Index​​