Form Dhcs 0007 - California Acceptable Citizenship And Identity Documents (Laotian) - Health And Human Services Agency

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State of California – Health and Human Services Agency
Department of Health Care Services
gvdtlkodkogxa o rq o ]tg,n v Cc]try l 6 f ]a d ltotlj ; o8q ; [5 d 7q o mu j l k,kfpv,Ia [ wfh
dq f \kp.\j g ;q h k ;j k z6 h I h v C0= c ]tz6 h I a [ zq o xt3spf
lj ; os^ k p mu j g xa o rq o ]tg,n v Cc]txt-k-q o ltstia 4 8h v CltcfCs^ a d 4ko
Medi-Cal
1a h C 1n o dkogxa o rq o ]tg,n v C c]t1a h C 1n o ]a d ltotlj ; o8q ; [5 d 7q o D r;dgIq k lk,kfpv,Ia [ wfh l tgrkt]kpdkogvdtlkomu j [ q j C w;h 0 h k C]5 j ,
ou h g mq j k oa h o D 4h k ;j k mj k o[+ , u g vdtlko8q h o lt[a [ F mj k o8h v C0= g vq k gvdtlkolegoq k mu j w fh I a [ dkoIa [ IvC9kdvq C dkomu j v vdgvdtlkooa h o D
legoq k mu j w fh 9 kddkova f gvdtlko9t[+ 4 n d pv,Ia [ D
mkCmu j C j k pmu j l 5 f le]a [ rq o ]tg,n v C s^ n x t-k-q o ltstia 4 mu j 9 try l 6 f s^ a d 4ko1a h C 1n o ma C dkogxa o rq o ]tg,n v C c]tdkory l 6 f ]a d ltotlj ; o8q ;
[5 d 7q o d+ c ,j o dko,u g vdtlko.fob j C fa j C 8+ w xou h G
|a C ln g fu o mkCltstia 4 -b j C vvd.sh 3 fp[+ 9 eda f
g4y C \q f vkp5 c ]h ; d+ p v,Ia [ wfh
(
)
.[1a C 1n o dkowfh l a o -kf
s^ n
(N-550
N-570)
.[1a h C 1n o dkogxa o rq o ]tg,n v Cltstia 4
s^ n
(N-560
N-561)
s^ n
4h k ;j k mj k o[+ , u g vdtlko.fob j C .o[a o fkgvdtlko0h k Cgmy C ou h F 9q j C 9a f sk
gvdtlkodkogxa o rq o ]tg,n v Cob j C 1j k C9kd]kpdko0h k C]5 j , ou h G
.[1a h C 1n o dkogdu f .oltstia 4
[a o mb d le,t3o7q ; 0vCia 4 [kodkC s^ n 0 vCia 4 -b j C ltcfC.sh g sa o vkp5
c]tdkogxa o rq o ]tg,n v C s^ n l t4komu j g du f 0vCz6 h I h v C0=
.[1a h C 1n o dko]kpCkodkogdu f
(DS-1350)
[a o mb d le,t3o7q ; -q o gzq j k -u o u 7 k vy o fPocfC
(Seneca Indian) *
]kpCkodkogdu f .o8j k Cxtgmf0vCrq o ]tg,n v Cltstia 4
(FS-240)
sh v Cdkof6 c ]le,t3o7q ; 0vC-k;vy o fPocfC -b j C [a o mb d -k;
.[1a h C 1n o dkogdu f mu j v vd.sh 3 fpdt-;Cxt9eia 4
ok;k39 vy o fPocfC
(Navajo Indians) *
s^ n
(FS-545
DS-1350)
c9h C dkodko]q C mt[Podkogdu f -b j C 4b d [a o mb d w;h . ortcodlt4y 8 y
[a f xt9e8q ; xt-k-q o ltstia 4
s^ n
(I-197
I-179)
le7a o xt9eia 4 1j 6 . oltstia 4
(U.S. State Vital Statistics) *
[a f vtg,]y d a o vy o fPocfC
(I-872)
[a o mb d dkogdu f lkmk]tot.oltstia 4 mu j ] j k -h k -b j C 4n d [a o mb d gdu o
xu
5
[a f xt9e8q ; ovmgmu o ,kgia P ok
(Northern Marianas) (I-873)
s^ a C 9kd[5 d 7q o oa h o wfh g du f c]h ;
*
7ela j C lkog]n h v CdkoIa [ [5 f [5 o me -b j C cltcfC.sh g sa o ;j k gdu f .oltstia 4
0= h 7 ;k,dj k ;-n j C ,u ] kpg-a o 0vCcrf\= s^ n o kCztf5 C 7a o -n j C gxa o z6 h 1 6 j
s^ a d 4ko1a h C 1n o dkoIa [ gvq k gfa d -n j C gdu f ovdltstia 4 ,k]h P Cgxa o ]6 d
.og;]kgfa d gdu f
*
c]tgfa d 16 j . odko75 h , 7vCmkCIj k Cdkp c]tmkCdq f \kp0vCr+ c ,j
]kp-n j 0 vC-k;rn h o g,n v Cvt]kltdh k 9kdsh v Cdkof6 c ]-k;
-n j C gxa o rq o ]tg,n v Cltstia 4
s^ n
(IR-3
IR-4)
vy o fPocfC
(Bureau of Indian Affairs) *
s^ a d 4ko1a h C 1n o dkogxa o ]k-tdkorq o ]tgIn v o0vCltstia 4 dj v o;a o mu
gvdtlkodkoIa [ g0q h k 16 j . olt4kortpk[ko;y - k-u [ F s^ n l t4k[a o vn j o M
,y 4 5 o k
1
1976
mu j l tcfC.sh g sa o ;j k gdu f .oltstia 4
*
[a o mb d dkogxa o mtskoltstia 4 -n j C ltcfC.sh g sa o g4u C lt4komu j g du f
[a o mb d fh k odkocrf
[+ c ,j o [a o mb d dkola d 1kxh v Cda o rtpkf
) *
(
.oltstia 4
*
8h v C]q C ;a o mu 1 j k C|h v p
5
xu d j v odkoIh v C0=
Medi-Cal
7a h C mevy f 0vC mj k o
[a o mb d 3IC\= . oltstia 4 -b j C [a o mb d .og;]kmu j [ 5 d 7q o oa h o gdu f
*
c]tltcfC.sh g sa o g4y C lt4komu j g du f .oltstia 4 D
[a o mb d dkoxtda o ra p -u ; y f F l5 0 trk[ s^ n vn j o M
*
le]a [ gfa d vkp5 8 j e d;j k
16
xu F 8h v C[a o mb d .dh g ;]kgdu f D
[a o mb d fh k olklt|k-n j C 4n d [a o mb d w;h . oltstia 4 rkp.o
3
mj k o8h v C9a f skgvdtlkomu j 1 6 j v a o fa [ 8q h o M.o]kpdkodj v ogmq j k mu j 9 tgIa f wfh D
gfn v ooa [ c8j , n h g du f -n j C ltcfC.sh g sa o g4u C lt4komu j g du f .oltstia 4
c]t;a o gfn v oxu g du f s^ n v kp5
4h k ;j k mj k o[+ l k,kf9a f skgvdtlkodkogxa o rq o ]tg,n v C.fMgs^ q j k ou h w fh
[a o mb d 0vC3ICIPo0a h o vko5 [ ko-n j C ltcfC.sh g sa o g4u C lt4komu j g du f
9q j C 0= I h v C.sh z 6 h . spj l vC7q o xtdv[2v,c]tg-a o -n j . o|a C ln 7 e.sh d ko
.oltstia 4 F ;a o mu 9 q f -n j g 0q h k 3ICIPoF ;a o gfn v oxu g du f F -n j c ]tlt4komu j
dkogxa o rq o ]tg,n v CD z6 h . spma C lvC7q o oa h o 8h v C,u g vdtlko1a h C 1n o 8q ; 0vC
gdu f 0vCr+ c ,j
g0q k gvCc]t1a h C 1n o dkogxa o rq o ]tg,n v Cltstia 4 F c]trPCc8j | b j C .olvC
7q o oa h o ,u 7 ;k,dj P ;ra o da [ mj k oD
c]t
gvdtlkodko1a h C 1n o ]a d ltotlj ; o8q ; [5 d 7q o |b j C 1j k C9kd ]kpdko0h k C]5 j , ou h G
.[0a [ 0u j - b j C vvd.sh 3 fpia 4 s^ n v kokg0f.oltstia 4 rh v ,da [ ,u I 6 [
[a f xt9e8q ; 0h k ik-dko0vCia 4 [kodkCF ia 4 s^ n m h v C4y j o
s^ n 0 = h , 6 o vn j o M mu j [ q j C g4y C 8q ; [5 d 7q o
rh v ,da [ ,u 0 = h , 6 o [5 d 7q o c[[fP;da [ .[0a [ 0u j
[a f xt9e8q ; oa d IPorh v ,da [ ,u I 6 [
[a f xt9e8q ; [5 d 7q o mu j 1 6 j r kp.8h d kof6 c ]0vCmtskoltstia 4
[a f xt9e8q ; mtskoltstia 4 s^ n [ a o mb d dkogdomtsko
|a C ln g fu o mkCltstia 4
vvd3fp[+ , u d ko9eda f
(
)
8+ | h k s^ a C
DHCS 0007 (12/07) – Laotian
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