Form Dhcs 0004 - California Request For California Birth Record (Laotian) - Health And Human Services Agency

ADVERTISEMENT

State of California – Health and Human Services Agency
Department of Health Care Services
7eIh v C0= g vq k [a o mb d dkogdu f .oia 4 7k]y 2 = g oa P
lk,kf0= g vq k [a o mb d dkogdu f .sh l e]a [ [5 d 7q o mu j g du f .oia 4 7k]y 2 = g oa P wfh — gIa f .sh 2 iu !
Medi-Cal
;a o mu , n h o u h G
gfn v oG
;a o G
xu G
;y m u d koIh v C0= G
9q j C xtdv[2v,ou h D ry , s^ n 0 Po
-n j 0 vC[5 d 7q o mu j x tdv[2v,ou h G
-n j G
-n j d kCG
ok,ltd5 o G
8q ; ry , .spj 1 j k CIP[Ih v pD
mj k olk,kfoe.-h 0 = h , 6 o
[a o mb d dkogdu f 0vCz6 h . fmu j m j k o8h v CdkoL
9kdlegoq k .[gdu f ,k8n j , ]q C
-n j m u j 1 6 j . o.[1a h C 1n o dkogdu f G
-G
-n j d kCG
ok,ltd5 o G
.o2v,ou h w fh D
9q j C oegvq k 2v, s^ n l q j C 2v,
4h k [5 d 7q o ou h g xa o ]6 d [5 o meF 9q j C 0Po-n j 0vC]6 d [5 o meG
-n j G
-n j d kCG
ok,ltd5 o G
mkCwxltou g 4y C sh v Cdko
la C 7q , lq C g7ktxt9eg0f
grfG
-kp
py C
0vCmj k oD
;a o gfu n v oxu g du f G
gfn v oG
;a o G
xu G
4h k ;j k mj k o,u [ a o sksp5 h C pkd
.odkoxtdv[2v,ou h F 9q j C
g,n v Cc]t7k;8u h m u j g du f G
g,n v CG
-n j 7 k;8u h . oia 4 7k]y 2 = g oa P G
3misksh v Cdkola C 7q ,
ok,ltd5 o dj v oc8j C Cko0vCc,j G
lq C g7ktxt9eg0f0vCmj k oD
-n j G
-n j d kCG
ok,ltd5 o G
r;dgIq k vkf[+ l k,kfsk
-n j 0 vCrG
-n j G
-n j d kCG
ok,ltd5 o G
[a o mb d dkogdu f .sh m j k owfh D
4h k ;j k gxa o co;ou h F mj k o8h v C
g]dmu . [1a h C 1n o dkogdu f
G
4h k ;j k mj k oI6 h
# (
)
9a f sks^ a d 4kovn j o M mu j 1 a h C 1n o
dkogxa o rq o ]tg,n v CD
-n j 0 vC[5 d 7q o 8+ w xmu j m j k o8h v Cdko[a o mb d dkogdu f G
-n j G
-n j d kCG
ok,ltd5 o G
4h k ;j k r;dgIq k ,u [ a o mb d dko
gdu f mu j m j k o4k,skF mj k od+ p a C
4h k [5 d 7q o ou h g xa o ]6 d [5 o meF 9q j C 0Po-n j 0vC]6 d [5 o meG
-n j G
-n j d kCG
ok,ltd5 o G
8h v C9a f sks^ a d 4ko1a h C 1n o
grfG
]a d ltot8q ; [5 d 7q o .sh D
-kp
py C
sh v Cdkola C 7q , lq C g7ktxt9e
;a o gfu n v oxu g du f G
gfn v oG
;a o G
xu G
7k;8u h 8 h v Cdko0= h , 6 o mu j 9 egxa o
grn j v .-h 7 q h o sk[a o mb d dkogdu f
g,n v Cc]t7k;8u h m u j g du f G
g,n v CG
-n j 7 k;8u h . oia 4 7k]y 2 = g oa P G
.oia 4 7k]y 2 = g oa P grn j v ry l 6 f dkogxa o
ok,ltd5 o dj v oc8j C Cko0vCc,G
-n j G
-n j d kCG
ok,ltd5 o G
rq o ]tg,n v CD mj k o[+ 9 egxa o 8h v C.sh
0= h , 6 o ou h D c8j 4 h k ;j k mj k o[+ . sh F
-n j 0 vCrG
-n j G
-n j d kCG
ok,ltd5 o G
7k;8u h d + v kf[+ l k,kf7q h o sk[a o mb d
dkogdu f wfh D
g]dmu . [1a h C 1n o dkogdu f
G
4h k ;j k mj k oI6 h
# (
)
4h k ;j k mj k o8h v Cdko[a o mb d dkogdu f s^ k pd;j k lvClt[a [ F 9q j C xtdv[2v,8n j , vu d va o |b j C D
DHCS 0004 (06/07) – Laotian
Page 1 of 1

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go