返回 MCED 表格主页Medi-Cal 资格部门 (MCED) 表格按表格编号的字母顺序列出，并且可能包含其他语言（如有）。PDF 填写和打印表格可以在线填写并打印为硬拷贝，然后签名并邮寄或亲自提交给资格审查工作人员进行处理。

管委会 00 Forms

• MC 05 (07/15) – Military Verification and Referral Form
• MC 13 (04/26) – 公民身份、外国人身份和移民身份声明
• MC 14 A (07/22) – Qualified Low-Income Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individuals(QI) Application
• 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