Form Mc 239 Dra-6 - Information Notice (Chinese) printable pdf download

Form Mc 239 Dra-6 - Information Notice (Chinese)

Department of Health Care Services

State of California—Health and Human Services Agency

(COUNTY STAMP)

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Medi-Cal

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Medi-Cal

(BIC)

BIC

Medi-Cal

Medi-

Cal

Medi-Cal

__________–_________–__________

Medi-Cal

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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__________________________

INS

Medi-Cal

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

”

(DHCS 6155)

Medi-Cal

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medi-Cal

“Important Information for Medi-Cal Applicants”

X____________________________________________________________

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50175

Medi-Cal

MC 368 (Chinese) (06/07)

Form Mc 239 Dra-6 - Information Notice (Chinese)