加州醫療補助健康保健計劃資格部門MC 00 表格
返回 MCED 表格主頁加州醫療補助健康保健計劃資格部門 (MCED) 表格按表格編號的字母順序在下面列出,並且可能包括替代語言(如果有)。PDF 填寫和列印表格可以在線填寫,並打印成紙本,以簽名並郵寄或親自提交給合資格工作人員進行處理。
主持人 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
- 附加:縣列表
- 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