Medi-Cal Eligibility Division Translated Forms: Tagalog
Medi-Cal Eligibility Division (MCED) forms are listed below, alphabetically, by form number and has been translated into Tagalog.
PDF fill and print forms may be completed online and printed to hardcopy to be signed and mailed in or submitted in person to an eligibility worker for processing.
DHCS 表格：他加禄语
- DHCS 0001 (01/08) (Tag) - 申请加州医疗保险的美国公民和国民必须出示公民身份和身份证明
- DHCS 0002 (01/08) (Tag) - 公民身份和身份证明--对美国公民或国民的加州医疗保险受益人的新要求
- DHCS 0005 (02/08) (标签) - 收到公民身份或身份证件
- DHCS 0007 (12/07) (标签) - 可接受的公民身份和身份证件
- DHCS 0008 (01/08) (标签) - 美国公民或国民儿童填写《健康家庭》的公民身份和身份证明要求
- DHCS 0009 (09/07) (Tag) – Affidavit of Identity for U.S. Citizen or National Children Under 18
- DHCS 0011 (06/08) (标签) - 可接受的公民身份或身份证件证明
MC 表格：他加禄语
- MC 0021 (04/07) (标签) – Medi-Cal 到 Healthy Families 过渡同意书
- MC 176 S (03/09) (Tag) – Medi-Cal Status Report
- MC 209 (05/12) (Tag) - 怀孕期间和分娩后加州医保承保范围的变更
- MC 210 RV (05/11)（标签）– Medi-Cal 年度重新确定
- MC 219 (11/15) (Tag) – Important Information For Persons Requesting Medi-Cal
- MC 223 C (06/11) (标签) – 仅限 Medi-Cal 儿童申请人的补充事实陈述
- MC 223 (10/09) (Tag) – Applicant’s supplemental statement of facts for Medi-Cal Adult Applicant Only
- MC 239 DRA-6（02/10）（标签）--信息通知--无法通过社会保障局核实美国公民身份/身份
- MC 264 (09/11) (Tag) - 孕妇推定资格计划患者概况介绍
- MC 371 (06/09) (标签) – 其他家庭成员申请Medi-Cal
- MC 372 (12/21) (标签) – 乳腺癌和宫颈癌治疗项目 (BCCTP) 宣传单
- MC 4035 (04/08) (标签) – Medi-Cal 同意书
MC 信息通知：他加禄语
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MC 信息通知 003 (05/13) (标签) – 早期和定期筛查、诊断和治疗服务