Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-Cal Must Show Proof Of Citizenship And Identity (Armenian) - Health And Human Services Agency Page 4

ADVERTISEMENT

State of California – Health and Human Services Agency
Department of Health Care Services
ÐݹϳóÇ³Ï³Ý ²ñÛ³Ý ²ëïÇ׳ÝÇ ìÏ³Û³Ï³Ý (Certificate
16 ï³ñ»Ï³ÝÇó ÷áùñ »ñ»Ë³ÛÇ Ñ³Ù³ñ, áñÁ ãáõÝÇ ù³Õ³ù³óÇáõÃÛ³Ý
of Degree of Indian Blood) ϳ٠³ÛÉ` ØdzóÛ³É Ü³Ñ³Ý·Ý»ñÇ
Ù³ëÇÝ Ñ³ëï³ï³·Çñ, ¹áõù ϳñáÕ »ù Ý»ñϳ۳óÝ»É`
²Ù»ñÇÏÛ³Ý ÐݹϳódzϳÝ/²ÉÛ³ëϳÛÇ μÝÇÏ ó»Õ³ÛÇÝ
ÌÝÝ¹Û³Ý í³ÛñÁ »õ ³Ùë³ÃÇíÁ óáõÛó ïíáÕ »ñ»Ë³ÛÇ ÇÝùÝáõÃÛ³Ý
÷³ëï³ÃáõÕà (ê.î. American Indian/Alaska Native Tribal
Ù³ëÇÝ Ñ³ëï³ï³·Çñ` ëïáñ³·ñí³Í »ñ»Ë³ÛÇ ÍÝáÕÇ, ËݳٳϳÉÇ
document)
ϳ٠ËݳÙáÕ ³½·³Ï³ÝÇ ÏáÕÙÇó:
ØdzóÛ³É Ü³Ñ³Ý·Ý»ñÇ Ìáí³ÛÇÝ ë³Ñٳݳå³Ñ áõÅ»ñÇ
Medi-Cal ϳ٠Healthy Families/Medi-Cal ÙdzóÛ³É ¹ÇÙáõÙݳ·Çñ,
³é»õïñ³Ï³Ý-Íáí³ÛÇÝ ù³ñï (ê.î. Coast Guard Merchant
áñÁ óáõÛó Ïï³ »ñ»Ë³ÛÇ ÍÝÝ¹Û³Ý ÃÇíÁ »õ í³ÛñÁ »õ áñÁ
Mariner Card)
ëïáñ³·ñí³Í ÏÉÇÝÇ »ñ»Ë³ÛÇ ÍÝáÕÇ, ËݳٳϳÉÇ Ï³Ù ËݳÙáÕ
ºñ»ù ϳ٠³í»ÉÇ Ñ³ëï³ïáÕ ïÇåÇ ÷³ëï³ÃÕûñ, ÇÝãå»ë
³½·³Ï³ÝÇ ÏáÕÙÇó:
³ß˳ï³Ýù³ÛÇÝ ID ù³ñï, high school-Ç Ï³Ù ùáÉ»çÇ íϳ۳ϳÝ,
³ÙáõëÝáõÃÛ³Ý íϳ۳ϳÝ, ³ÙáõëݳÉáõÍáõÃÛ³Ý í×Çé, ÇÝãå»ë ݳ»õ
18 ï³ñ»Ï³ÝÇó ÷áùñ »ñ»Ë³ÛÇ Ñ³Ù³ñ ϳñ»ÉÇ ¿ û·ï³·áñÍ»É »ñ»Ë³ÛÇ
ϳÉí³ÍÇ í³í»ñ³·ñ»ñ/ë»÷³Ï³Ý³ÃÕûñ
ÇÝùÝáõÃÛ³Ý Ù³ëÇÝ Ñ³ëï³ï³·Çñ` ëïáñ³·ñí³Í »ñ»Ë³ÛÇ ÍÝáÕÇ,
ËݳٳϳÉÇ Ï³Ù ËݳÙáÕ ³½·³Ï³ÝÇ ÏáÕÙÇó, »Ã» ¹åñáó³Ï³Ý ID
16 ï³ñ»Ï³ÝÇó ÷áùñ »ñ»Ë³ÛÇ Ñ³Ù³ñ ÏÉÇÝÇϳÛÇ, μÅßÏÇ Ï³Ù
ù³ñï ϳ٠í³ñáñ¹³Ï³Ý Çñ³íáõÝù ïñ³Ù³¹ñ»ÉÇ ã»Ý:
ÑÇí³Ý¹³ÝáóÇ ³ñӳݳ·ñáõÃÛáõÝÝ»ñ
16 ï³ñ»Ï³ÝÇó ÷áùñ »ñ»Ë³ÛÇ Ñ³Ù³ñ ¹åñáóÇ, Ù³ÝϳÙëáõñÇ Ï³Ù
ÜßáõÙ. ÆÝùÝáõÃÛ³Ý Å³ÙÏ»ï³Ýó ÷³ëï³ÃÕûñÁ ÇÝùÝáõÃÛ³Ý ÁݹáõÝ»ÉÇ
ó»ñ»Ï³ÛÇÝ ËݳÙùÇ ·ñ³ÝóáõÙÝ»ñ, Ý»ñ³éÛ³É ï»Õ»Ï³ÝùÝ»ñ:
³å³óáõÛóÝ»ñ »Ý:
ø³áõÝÃÇÝ Ïëïáõ·Ç ¹åñáóÇ Ñ»ï:
гëï³ï³·Çñ ëïáñ³·ñí³Í ïÝûñ»ÝÇ Ï³Ù Ï³é³í³ñãÇ ÏáÕÙÇó
μݳϳñ³Ý³ÛÇÝ ËݳÙùÇ í³ÛñáõÙ ³åñáÕ Ñ³ßٳݹ³ÙÝ»ñÇ Ñ³Ù³ñ
DHCS 0001 (01/08) – Armenian
Page 4 of 4

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (korean) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (korean) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (vietnamese) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (vietnamese) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (tagalog) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (tagalog) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (spanish) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (spanish) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (russian) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (russian) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (laotian) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (laotian) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (farsi) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (farsi) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (chinese) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (chinese) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (arabic) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (arabic) - Health And Human Services Agency Legal
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (hmong) - Health And Human Services Agency Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (hmong) - Health And Human Services Agency Legal

Related Categories

Parent category: Legal
Download
Go
Page of 4