Form Mc 176 S - Medi-Cal Status Report (Armenian) printable pdf download

State of California - Health and Human Services Agency

Department of Health Care Services

Ð²ÞìºîìàôÂÚàôÜ §MEDI-CAL¦-Æ Î²ð¶²ìÆÖ²ÎÆ Ø²êÆÜ

àôÞ²¸ðàôÂÚàôÜ: Ü²Ð²Ü¶Æ úðºÜøÀ ä²Ð²ÜæàôØ ¾, àð ¸àôø ÎÆê²ØÚ² Ð²ÞìºîìàôÂÚàôÜ

Èð²òÜºø Òºð Î²ð¶²ìÆÖ²ÎÆ Ø²êÆÜ

Òºð §MEDI-CAL¦-À ä²Ðä²ÜºÈàô Ð²Ø²ð ¸àôø äºîø ¾ ìºð²¸²ðÒÜºø ²Úê ÂºðÂÆÎÀ ØÆÜâºì

__________ -À: ÊÜ¸ðàôØ ºÜø ¶ðºÈ îä²î²èºðàì ºì Â²Ü²øàì:

Ì³ÝáõóÙ³Ý ³Ùë³ÃÇíÁ _____________________

¶áñÍÇ Ñ³Ù³ñÁ _____________________________

²ßË³ï³ÏóÇ ³ÝáõÝÁ ________________________

²ßË³ï³ÏóÇ Ñ³Ù³ñÁ _______________________

²ßË³ï³ÏóÇ Ñ»é³Ëáë³Ñ³Ù³ñÁ _____________

²ßË³ï³Ýù³ÛÇÝ Å³Ù»ñÁ ____________________

ØÇ Éñ³óñ»ù ³Ûë Ã»ñÃÇÏÁ, »Ã» Ò»ñ ÁÝï³ÝÇùáõÙ §Medi-Cal¦ »Ý ëï³ÝáõÙ ÙÇ³ÛÝ 65 ï³ñ»Ï³Ý

Ï³Ù ³í»ÉÇ ï³ñ»ó, ÏáõÛñ ³ÝÓÇÝù, ÙÇÝã¨ Ù»Ï ï³ñ»Ï³Ý Ýáñ³ÍÇÝÝ»ñ, ÙÇÝã¨ 21 ï³ñ»Ï³Ý

Ñá·»½³í³ÏÝ»ñ, §CalWORKs¦ ëï³óáÕÝ»ñ Ï³Ù ³ÛÝåÇëÇ ³ÝÓÇÝù, áñáÝù ³ñ¹»Ý Çñ»Ýó ÑÕÇáõÃÛ³Ý Ï³Ù

Ñ³ßÙ³Ý¹³ÙáõÃÛ³Ý Ù³ëÇÝ ï»ÕÛ³Ï »Ý å³Ñ»É §Medi-Cal¦-Ç ³ßË³ï³ÏóÇÝ:

Ò»ñ §Medi-Cal¦-Á å³Ñå³Ý»Éáõ Ñ³Ù³ñ ¸áõù å»ïù ¿ Éñ³óÝ»ù ³Ûë Ã»ñÃÇÏÁ, »Ã» ¸áõù

§Medi-Cal¦ ëï³óáÕ ÍÝáÕ »ù: Ð³ÛïÝ»ù Ù»½ í»ñçÇÝ 6 ³ÙëáõÙ Ò»½ Ùáï ï»ÕÇ áõÝ»ó³Í

÷á÷áËáõÃÛáõÝÝ»ñÇ Ù³ëÇÝ: ºÃ» Ò»½ û·ÝáõÃÛáõÝ ¿ Ñ³ñÏ³íáñ ³Ûë Ã»ñÃÇÏÁ Éñ³óÝ»Éáõ Ñ³ñóáõÙ,

½³Ý·³Ñ³ñ»ù Ò»ñ ³ßË³ï³ÏóÇÝ: Ò»ñ ³ßË³ï³ÏóÇ ³ÝáõÝÁ ¨ Ñ»é³ËáëÇ Ñ³Ù³ñÁ Ýßí³Í »Ý í»ñÁ:

´³ÅÇÝ 1: ºÃ» í»ñçÇÝ 6 ³ÙëáõÙ ³ÛÝåÇëÇ ÷á÷áËáõÃÛáõÝ ãÇ »Õ»É, áñÇ Ù³ëÇÝ

å»ïù ¿ Ñ³ÛïÝ»É`

•

êïáõ·»ù 2-ñ¹ µ³ÅÝáõÙ Ýßí³Í Ï»ï»ñÁ (ßñç»ù ¿çÁ):

•

ºÃ» Ñ³ÛïÝ»Éáõ ÷á÷áËáõÃÛáõÝ ãÏ³, Ýß³Ý ¹ñ»ù ³Ûë í³Ý¹³ÏáõÙ. p ÷á÷áËáõÃÛáõÝ ãÏ³

•

ØÆ Éñ³óñ»ù 2-ñ¹ µ³ÅÇÝÁ:

•

²Ýó»ù 3-ñ¹ µ³ÅÝÇÝ` Ñ³Ï³é³Ï ÏáÕÙáõÙ: ¸áõù å»ïù ¿ ëïáñ³·ñ»ù ¨ Ãí³·ñ»ù ³Ûë Ã»ñÃÇÏÁ:

•

ØÇÝã¨ ³Ûë ¿çÇ í»ñ¨áõÙ Ýßí³Í ³Ùë³ÃÇíÁ, Éñ³óí³Í Ã»ñÃÇÏÁ í»ñ³¹³ñÓñ»ù ßñç³ÝÇÝ:

•

ú·ï³·áñÍ»ù ÏÇó, Ñ³ëó» å³ñáõÝ³ÏáÕ Íñ³ñÁ: Ü³Ù³Ï³ÝÇß Ñ³ñÏ³íáñ ã¿:

ºÃ» í»ñçÇÝ 6 ³ÙëáõÙ ºÔºÈ ºÜ ÷á÷áËáõÃÛáõÝÝ»ñ, áñáÝó Ù³ëÇÝ Ñ³ñÏ³íáñ ¿ Ñ³ÛïÝ»É`

• Þñç»ù ¿çÁ: Èñ³óñ»ù 2-ñ¹ µ³ÅÇÝÁ:

• ²Ýó»ù 3-ñ¹ µ³ÅÝÇÝ: ¸áõù å»ïù ¿ ëïáñ³·ñ»ù ¨ Ãí³·ñ»ù ³Ûë Ã»ñÃÇÏÁ:

• ØÇÝã¨ ³Ûë ¿çÇ í»ñ¨áõÙ Ýßí³Í ³Ùë³ÃÇíÁ, Éñ³óí³Í Ã»ñÃÇÏÁ í»ñ³¹³ñÓñ»ù ßñç³ÝÇÝ:

• ö³ëï³ÃÕÃ»ñ ÙÇ áõÕ³ñÏ»ù:

• ú·ï³·áñÍ»ù ÏÇó, Ñ³ëó» å³ñáõÝ³ÏáÕ Íñ³ñÁ: Ü³Ù³Ï³ÝÇß Ñ³ñÏ³íáñ ã¿:

ÐÆÞº°ø: ¸àôø äºîø ¾ êîàð²¶ðºø ²Úê ÂºðÂÆÎÆ Ð²Î²è²Î ºðºêÆÜ:

Þðæºø ¾æÀ u

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MC 176 S (Armenian) (03/09)

Form Mc 176 S - Medi-Cal Status Report (Armenian)

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