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Medi-Cal Eligibility Division Translated Forms: Laotian

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Medi-Cal Eligibility Division (MCED) forms are listed below, alphabetically, by form number and has been translated into Laotian.
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 Forms: Laotian

DHCS 0001 (01/08) (Lao) - U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity

DHCS 0002 (01/08) (Lao) - Proof of Citizenship and Identity--New Requirements for Medi-Cal Beneficiaries Who Are U.S. Citizens or Nationals

DHCS 0003 (06/07) (Lao) - Affidavit of Reasonable Effort to Get Proof of Citizenship

DHCS 0004 (06/07) (Lao) - Request for California Birth Record

DHCS 0005 (02/08) (Lao) - Receipt of Citizenship or Identity Documents

DHCS 0006 (08/07) (Lao) - Proof of Citizenship and Identity

DHCS 0007 (12/07) (Lao) - Acceptable Citizenship and Identity Documents

DHCS 0008 (01/08) (Lao) - Proof of Citizenship and Identity Requirements -- For Children Who Are U.S. Citizens or Nationals Filling Out the Healthy Families/Medi-Cal Joint Application

DHCS 0009 (09/07) (Lao) - Affidavit of Identity for U.S. Citizen or National Children Under 18

DHCS 0011 (06/08) (Lao) - Proof of Acceptable Citizenship or Identity Documents

MC Forms: Laotian

MC 0021 (04/07) (Lao) - Medi-Cal to Healthy Families Bridging Consent Form

MC 372 (12/21) (Lao) - Breast and Cervical Cancer Treatment Program (BCCTP)

Last modified date: 9/9/2022 3:36 PM