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 Page 2
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4State of California – Health and Human Services Agency
Department of Health Care Services
ﻓور ا ً؟
ﻣﺎذا إذا ﻛﻧت ارﻳد ﺣﻘوق
ﻣﺎذا اذا ﻟم اﺳﺗطﻊ ﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت ﺟﻧﺳﻳﺔ او ﺷﺧﺻﻳﺔ؟
Medi-Cal
ﺗﺳﺗطﻳﻊ ﻣﻌظم اﻟﻧﺳﺎء اﻟﺣواﻣل واﻷطﻔﺎل اﻟﺣﺻول ﻋﻠﻰ
ﻻ ﻳزال ﻳﺟب ﻋﻠﻳك اﻟﺗﻘدم ﺑﺎﻟطﻠب ﻓور ا ً وﺗﻘدﻳم وﺛﻳﻘﺔ
ﻣؤﻗﺗ ﺎ ً اﺛﻧﺎء ﻗﻳﺎم اﻟﻣﻘﺎطﻌﺔ ﺑﻣراﺟﻌﺔ طﻠب
.ً اﻷﺛﺑﺎت ﻻﺣﻘ ﺎ
Medi-Cal
.اﺷﺗراﻛك
ﺣﺗﻰ ﺗﻘوم
ﻻ ﺗﺑدأ ﺗﻐطﻳﺗك اﻟﺷﺎﻣﻠﺔ ﻓﻲ ﺑرﻧﺎﻣﺞ
Medi-Cal
ﺑﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ. اذا ﻟم ﺗﺳﺗطﻊ ﺗﻘدﻳم
وﺛﺎﺋق اﻷﺛﺑﺎت وﻟﻛن ﻻ ﺗزال اﻟﺷروط اﻟﻣطﻠوﺑﺔ اﻻﺧرى
ﻫل ﻳﺟب ﻋﻠﻲ ﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ ﻛل
.ﺗﻧطﺑق ﻋﻠﻳك، ﻓﺳﻳﺗم ﺗﺣوﻳﻠك اﻟﻰ اﻟﺧدﻣﺎت اﻟﻣﺣدودة
ﺳﻧﺔ؟
ﺗﻐطﻲ اﻟﺧدﻣﺎت اﻟﻣﺣدودة ﺣﺎﻻت اﻟطوارئ، اﻟﺣﻣل
ﻻ. ﻋﻠﻳك ﺗﻘدﻳم دﻟﻳل اﻻﺛﺑﺎت ﻣرة واﺣدة - إﻣﺎ ﻋﻧد ﺗﻘدﻳم
.وﻣﻠﺣﻘﺎﺗﻪ، وﺧدﻣﺎت اﻟرﻋﺎﻳﺔ اﻟطوﻳﻠﺔ اﻷﺟل
اﻟطﻠب اول ﻣرة أو ﻋﻧد ﻣوﻋد ﻣراﺟﻌﺔ ﻗﺎﻧوﻧﻳﺔ اﺷﺗراﻛك
اذا ﻗﻣت ﺑﺗﻘدﻳم وﺛﻳﻘﺔ اﻷﺛﺑﺎت ﺧﻼل ﺳﻧﺔ واﺣدة ﻣن ﺗﺎرﻳﺦ
.اﻟﺳﻧوي
ﺗﻘدﻳم اﻟطﻠب، ﻓﺳﻳﺗم ﺗﻌدﻳل ﺧدﻣﺎﺗك ﻓﻲ ﺑرﻧﺎﻣﺞ
.اﻟﻰ ﺗﻐطﻳﺔ ﺷﺎﻣﻠﺔ اﺑﺗداء ا ً ﻣن ﺗﺎرﻳﺦ طﻠﺑك
Medi-Cal
، ﻫل ﻳؤﺛر ﻫذا اﻟﻘﺎﻧون ﻋﻠﻰ ﺧدﻣﺎﺗﻲ ﻣن
Food Stamps
إذا ﺗﻛﺑدت ﻣﺻﺎرﻳف طﺑﻳﺔ اﺛﻧﺎء طﻠﺑك ﻟوﺛﺎﺋق اﺛﺑﺎت
؟
، أو
أن ﺗﻘوم ﺑدﻓﻊ
ﺟﻧﺳﻳﺗك وﻫوﻳﺗك، ﻳﻣﻛن ﻟــ
Healthy Families
CalWORKs
Medi-Cal
ﻓواﺗﻳرك. اﺗﺻل ﺑـﺧدﻣﺎت اﻟﻣﺳﺗﻔﻳدﻳن ﻓﻲ ﻣدﻳرﻳﺔ ﺧدﻣﺎت
ﻻ. ﻣﺗطﻠﺑﺎت اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ اﻟﺟدﻳدة ﺗﻧطﺑق ﻓﻘط
اﻟرﻋﺎﻳﺔ اﻟﺻﺣﻳﺔ ﻓﻲ ﻛﺎﻟﻳﻔورﻧﻳﺎ ﻟﻠﺣﺻول ﻋﻠﻰ أﺟوﺑﺔ
ﻋﻠﻰ ﺑرﻧﺎﻣﺞ
.Medi-Cal
:ﻻﺳﺋﻠﺗك
.(916) 403-2007
ﻫل اﻧﺗم ﺑﺣﺎﺟﺔ اﻟﻰ وﺛﺎﺋق اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ واﻟﺷﺧﺻﻳﺔ
،ﻫل ﻋﻠﻰ اﻷطﻔﺎل ﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت ﺟﻧﺳﻳﺔ و ﺷﺧﺻﻳﺔ
اﻷﺻﻠﻳﺔ؟
أﻳﺿ ﺎ ً؟
ﻧﻌم. ﻧﺣن ﺑﺣﺎﺟﺔ اﻟﻰ وﺛﺎﺋق اﺛﺑﺎت اﻟﺟﻧﺳﻳﺔ أواﺛﺑﺎت
ﻧﻌم. اذا ﻛﺎن طﻔﻠك ﻣوﻟود ا ً ﻓﻲ ﻛﺎﻟﻳﻔورﻧﻳﺎ، اطﻠب ﻣن
.اﻟﺷﺧﺻﻳﺔ اﻷﺻﻠﻳﺔ. أو ﻧﺳﺦ ﻣﺻدﻗﺔ ﻣن ﺟﻬﺔ اﻻﺻدار
اﻟﻣﻘﺎطﻌﺔ اﻟﺗﺎﺑﻊ ﻟﻬﺎ ان ﺗﻘوم ﺑطﻠب ﺳﺟل اﻟوﻻدة ﻛدﻟﻳل
.اﺛﺑﺎت ﺟﻧﺳﻳﺔ
ﻫل اﺳﺗطﻳﻊ ارﺳﺎل وﺛﻳﻘﺔ اﻷﺛﺑﺎت ﺧﺎﺻﺗﻲ ﺑﺎﻟﺑرﻳد؟
ﺳﻧﺔ وﻗﻣت ﺑﺗﻌﺑﺋﺔ وﺗوﻗﻳﻊ
إذا ﻛﺎن طﻔﻠك ﺗﺣت ﻋﻣر
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أو اﺳﺗﻣﺎرة طﻠب ﻣﺷﺗرك ﻓﻲ
اﺳﺗﻣﺎرة ﺑرﻧﺎﻣﺞ
Medi-Cal
ﻧﻌم. ﺳﺗﻘوم اﻟﻣﻘﺎطﻌﺔ ﺑﺄﺧذ ﻧﺳﺦ واﻋﺎدة ارﺳﺎﻟﻬم ﻟك
ﻣﺛﺑت ﻓﻳﻪ ﺗﺎرﻳﺦ وﻣﻛﺎن
Healthy Families/Medi-Cal
ﺑﺎﻟﺑرﻳد. أو، ﻳﻣﻛﻧك اﺧذ اﻟوﺛﺎﺋق اﻟﻰ ﻣﻛﺗب اﻟﺧدﻣﺎت
.وﻻدة طﻔﻠك، ﻟﺳت ﺑﺣﺎﺟﺔ اﻟﻰ ﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت ﺷﺧﺻﻳﺔ
اﻷﺟﺗﻣﺎﻋﻳﺔ اﻟﻣﺣﻠﻲ. اطﻠب ﻣﻧﻬم اﺧذ ﻧﺳﺦ واﻋﺎدﺗﻬم
.ﻫذا اﻟطﻠب اﻟﻣوﻗﻊ ﻫو وﺛﻳﻘﺔ اﺛﺑﺎت ﺷﺧﺻﻳﺔ ﻟطﻔﻠك
(
)
.ﻓور ا ً ﻟك
.وﻻ ﻳزال ﻳﺟب ﻋﻠﻳك ان ﺗﻘدم وﺛﻳﻘﺔ اﺛﺑﺎت ﺟﻧﺳﻳﺔ
ﺳﻧﺔ أو أﻛﺛر، ﺳوف ﺗﺣﺗﺎج اﻟﻰ
إذا ﻛﺎن ﻋﻣر طﻔﻠك
16
ﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت ﺷﺧﺻﻳﺔ ﻟطﻔﻠك. اﻧظر ﺻﻔﺣﺔ
.3
ﺑرﻧﺎﻣﺞ
أذا ﺗﻘدم طﻔﻠك ﺑطﻠب ﻋن طرﻳق ﻣﻧﻔذ
،CHDP
اﻟﺗﻐذﻳﺔ اﻟﻣدرﺳﻳﺔ، أو طﻠب ﻣﺷﺗرك
Healthy Families/ﻓﻲ
ﻻ ﻳﻧﺑﻐﻲ ﻋﻠﻳك ﺗﻘدﻳم وﺛﻳﻘﺔ اﺛﺑﺎت اﻟﻰ أن
،Medi-Cal
ﻳﺗم طﻠﺑﻪ ﻣن ﻣﻛﺗب اﻟﺧدﻣﺎت اﻷﺟﺗﻣﺎﻋﻳﺔ ﻟﻠﻣﻘﺎطﻌﺔ
.اﻟﺗﺎﺑﻊ ﻟﻬﺎ
DHCS 0001 (01/08) – Arabic
Page 2 of 4
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