Form Mc 210 Rv - Medi-Cal Annual Redetermination Form (Armenian) Page 4
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4State of California—Health and Human Services Agency
Department of Health Care Services
´³ÅÇÝ 8.
²ÛÉ ï»Õ»ÏáõÃÛáõÝÝ»ñ ³éáÕç³å³Ñ³Ï³Ý Íñ³·ñÇ Ù³ëÇÝ ¨ áõÕ»·ñ»ñ
(a) Üß³Ý ¹ñ»ù ³Ûë í³Ý¹³ÏáõÙ, »Ã» Ò»ñ »ñ»Ë³Ý ͳËë»ñÇ µ³ÅÝáí §Medi-Cal¦ ¿ ëï³ÝáõÙ, ¨ ¸áõù ã»ù
ó³ÝϳÝáõÙ, áñ Ò»ñ »ñ»Ë³ÛÇ Ù³ëÇÝ ï»Õ»ÏáõÃÛáõÝÝ»ñÁ ïñ³Ù³¹ñí»Ý ó³Íñ ·Ý»ñáí
§Healthy Families Program¦-ÇÝ:
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(b) ¸áõù ó³ÝϳÝáõ±Ù »ù ï»Õ»ÏáõÃÛáõÝÝ»ñ ëï³Ý³É ÙÇÝ㨠21 ï³ñ»Ï³Ý »ñ»Ë³Ý»ñÇ Ñ³Ù³ñ
ݳ˳ï»ëí³Í ³Ýí׳ñ ³éáÕç³å³Ñ³Ï³Ý Íñ³·ñÇ Ù³ëÇÝ (§Child Health and Disability
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³Ûá
áã
Prevention Program¦-Ç, áñÁ ѳÛïÝÇ ¿ ݳ¨ CHDP ³ÝáõÝáí) :
(c) ¸áõù ó³ÝϳÝáõ±Ù »ù ï»Õ»ÏáõÃÛáõÝÝ»ñ ëï³Ý³É ÑÕÇ Ï³Ù ÏñÍùáí Ï»ñ³ÏñáÕ Ï³Ý³Ýó ¨ ÙÇÝã¨
5 ï³ñ»Ï³Ý »ñ»Ë³Ý»ñÇ Ñ³Ù³ñ ݳ˳ï»ëí³Í Éñ³óáõóÇã ëÝݹ³ÙûñùÇ ³Ýí׳ñ Íñ³·ñÇ
❑
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Ù³ëÇÝ (§Women, Infants, and Children Program¦-Ç, áñÁ ѳÛïÝÇ ¿ ݳ¨ WIC ³ÝáõÝáí) :
³Ûá
áã
(d) ¸áõù ó³ÝϳÝáõ±Ù »ù ï»Õ»ÏáõÃÛáõÝÝ»ñ ëï³Ý³É §Personal Care Services Program¦-Ç`
ï³ñ»ó, ÏáõÛñ ϳ٠ѳßٳݹ³Ù ³ÝÓ³Ýó` ï³Ý å³ÛÙ³ÝÝ»ñáõÙ ËݳÙù ïñ³Ù³¹ñíáÕ
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Íñ³·ñÇ Ù³ëÇÝ (áñÁ ѳÛïÝÇ ¿ ݳ¨ §In-Home Supportive Services¦ ³ÝáõÝáí):
³Ûá
áã
´³ÅÇÝ 9.
ëïáñ³·ñáõÃÛáõÝ ¨ ѳëï³ïáõÙ
²Ûë ѳñó³Ã»ñÃÇÏÁ Éñ³óÝáÕÁ å»ïù ¿ ϳñ¹³ ¨ ëïáñ³·ñÇ ëïáñ¨:
➤ ºë ëï³ó»É ¨ ϳñ¹³ó»É »Ù §Î³ñ¨áñ ï»Õ»ÏáõÃáõÝÝ»ñ §Medi-Cal¦-Ç ³Ý¹³ÙáõÃÛ³Ý Ñ³Ûó Ý»ñϳ۳óÝáÕÝ»ñÇ Ñ³Ù³ñ¦ (MC 219)
ѳñó³Ã»ñÃÇÏÇ ûñÇݳÏÁ:
➤ ºë ï»ÕÛ³Ï »Ù MC 219 ѳñó³Ã»ñÃÇÏáõÙ Ýßí³Í ÇÙ µáÉáñ å³ñï³íáñáõÃÛáõÝÝ»ñÇ Ù³ëÇÝ, ѳëϳÝáõÙ ¨ ѳÝÓÝ »Ù ³éÝáõÙ
ϳï³ñ»É ¹ñ³Ýù:
➤ ºë ѳëï³ïáõÙ »Ù, áñ ÷á÷áËáõÃÛáõÝÇó Ñ»ïá ï³ëÝ ûñí³ ÁÝóóùáõÙ Íñ³·ñÇÝ ï»ÕÛ³Ï Ïå³Ñ»Ù »Ï³ÙáõïÇ, ë»÷³Ï³ÝáõÃÛ³Ý
Ù»ç ï»ÕÇ áõÝ»ó³Í ¨/ϳ٠³ÛÉ Ï³ñ·Ç ÷á÷áËáõÃÛáõÝÝ»ñÇ Ù³ëÇÝ, áñáÝù ϳñáÕ »Ý ³½¹»É §Medi-Cal¦-Ç Çñ³í³ëáõÃÛ³Ý íñ³:
➤ ºë ѳëϳÝáõÙ »Ù, áñ µáÉáñ ïíÛ³ÉÝ»ñÁ, áñáÝù »ë ïñ³Ù³¹ñ»É »Ù ³Ûë ѳñó³Ã»ñÃÇÏÇ íñ³, ³Û¹ ÃíáõÙ` Ýå³ëïÝ»ñÇ ¨ »Ï³ÙáõïÇ
Ù³ëÇÝ ï»Õ»ÏáõÃÛáõÝÝ»ñÁ, ϳñáÕ »Ý áõëáõÙݳëÇñí»É ¨ ëïáõ·í»É:
➤ γÉÇýáéÝdzÛÇ Ý³Ñ³Ý·Ç ûñ»Ýë¹ñáõÃÛ³Ý Ñ³Ù³Ó³ÛÝ` Ï»ÕÍ íϳÛáõÃÛáõÝ ï³Éáõ ѳٳñ ¹³ï³Ï³Ý å³ï³ë˳ݳïíáõÃÛ³Ý
»ÝóñÏí»Éáõ ëå³éݳÉÇùÇ ï³Ï, »ë ѳÛï³ñ³ñáõÙ »Ù, áñ ³Ûë ѳñó³Ã»ñÃÇÏÇ íñ³ Ýßí³Í µáÉáñ ï»Õ»ÏáõÃÛáõÝÝ»ñÁ ×ßÙ³ñÇï ¨
×ß·ñÇï »Ý:
êïáñ³·ñáõÃÛáõÝ
²Ùë³ÃÇí
❑
ò»ñ»Ï³ÛÇÝ Ï³Ù áõÕ»ñÓÝ»ñ ÁݹáõÝáÕ Ñ»é³ËáëÇ Ñ³Ù³ñÁ
î³Ý Ñ»é³ËáëÇ Ñ³Ù³ñÁ
(»Ã» Ýáñ ѳٳñ ¿, Ýß³Ý ¹ñ»ù ³Ûëï»Õ)
ìϳÛÇ ëïáñ³·ñáõÃÛáõÝÁ (»Ã» ëïáñ³·ñáõÃÛ³Ý ÷á˳ñ»Ý Ýß³Ý ¿ ¹ñí³Í) , óñ·Ù³ÝÇãÁ ϳ٠û·ÝáÕ ³ÝÓÁ
— Þñç³ÝÇ Ý»ñùÇÝ û·ï³·áñÍÙ³Ý Ñ³Ù³ñ —
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