Form Dhcs 0002 - California Proof Of Citizenship And Identity (Laotian) - Health And Human Services Agency

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State of California – Health and Human Services Agency
Department of Health Care Services
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Medi-Cal
0= h d eoq f .\j l e]a [ z6 h I a [ zq o xt3spf
-b j C gxa o rq o ]tg,n v C s^ n x t-k-q o ltstia 4
Medi-Cal
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(SSI)
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– Medicare (
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(SSDI)
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(RSI – Title II)
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[5 d 7q o mu j , u v kp5 8 j e d;j k
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21
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Medi-Cal
gfa d mu j 1 6 j . o[h k ov5 x t4a , F 37Cdko-j ; pgs^ n v ]6 d [5 o meF s^ n 3 7Cdko
Kin-Gap
gfa d mu j 1 6 j . o37Cdkogfa d oh v pmu j 4 n d xt4y h ,
(Abandoned Baby Program)
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CalWORKs
9tgIa f co;.f 4h k ;j k 0h k rtg9q h k [+ c ,j o [5 d 7q o 0h k Cgmy C ou h L
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sks^ a d 4kodkogxa o rq o ]tg,n v Cc]t1a h C 1n o ]a d ltotlj ; o8q ; [5 d 7q o grn j v ln [
0vCmj k owfh D
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(
)
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g[y j C |h k
le]a [ ]kpdko gvdtlko1a h C
Medi-Cal. (
3
9q j C xtdv[ 2v,Ih v C0= [ a o mb d dkogdu f .oia 4 7k]y 2 = g oa P
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)
grn j v 0= . sh 7 k;8u h I h v C0= g vq k [a o mb d dkogdu f 0vCmj k oD 9kdoa h o F 9q j C lq j C
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(
)
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rq o ]tg,n v Cltstia 4 L
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4h k ;j k mj k o[+ c ,j o rq o ]tg,n v C s^ n xt-k-q o ltstia 4 F mj k o9e8h v C
mj k o[+ w fh g du f .oia 4 7k]y 2 = g oa P D 9q j C 8y f 8+ 7 k;8u h grn j v g[y j C ;j k
9a f skgvdtlkoc[[fP;da o da [ ly j C mu j m j k og7u p 9a f sk .sh c 8j d j v oD
g0q k g9q h k wfh 7 q h o rq [ [a o mb d dkogdu f mu j d q C da [ mj k o s^ n [ +
[+ , u s pa C xj P ocxCD
dj v omu j m j k o9t9j k p7j k le]a [ .[1a h C 1n o dkogdu f D
zq o xt3spfxtda o ra p 75 h , 7vC0vC0h k rtg9q h k 9tln [ 8+ fq o xko.fL
zq o xt3spf
0vCmj k o9t,u l n [ 8+ w x 4h k ;j k
Medi-Cal
mj k o,u g Cn j v ow07q [ 4h ; o8k,0= h d eoq f ma C \q f c]twfh r tpkpk,
1j k Clq , gsfzq o mu j 9 t9a f sks^ a d 4ko1a h C 1n o dkogxa o rq o ]tg,n v C
c]t]a d ltotlj ; o8q ; [5 d 7q o D mj k o8h v C[vdrtoa d Ckof6 c ]ly f my
wfh I a [ 0vCmj k o;j k mj k ode]a C rtpkpk,9a f sks^ a d 4ko1a h C 1n o 16 j D
DHCS 0002 (01/08) – Laotian
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