California Department of Health Care Services Forms

This document is used for providing proof of acceptable citizenship or identity documents in California. It is required for various purposes such as obtaining a driver's license or identification card.

This form is used for proving citizenship or identity for Medi-Cal applicants and beneficiaries who are U.S. citizens or nationals in California for Chinese-speaking individuals.

This Form is used for providing proof of acceptable citizenship or identity documents in California. It is available in Korean language as well.

This form is used for individuals in California to provide proof of acceptable citizenship or identity documents. It is available in Farsi (Persian) language.

This Form is used for receiving citizenship or identity documents in California. It is available in Farsi language.

This Form is used for acknowledging the receipt of citizenship or identity documents in California for Armenian individuals.

This form is used for acknowledging the receipt of citizenship or identity documents in California. It is available in Tagalog language to accommodate Tagalog-speaking individuals.

This form is used for acknowledging the receipt of citizenship or identity documents in California. It is available in Vietnamese language.

This form is used to request a birth record in California for individuals of Armenian descent. It is specifically designed for those who need to obtain a copy of their birth certificate with Armenian language information.

This Form is used to request a birth record in California and it is available in Korean.

This form is used to request a California birth record in the Tagalog language.

This Form is used for submitting a receipt of citizenship and identity documents in California. It is available in both English and Russian languages.

This form is used for recording the receipt of citizenship and identity documents for individuals of Hmong descent in California.

This form is used for requesting a birth record in California if you prefer to receive the form in Russian.

This form is used for requesting a California birth record for individuals of Hmong descent.

This Form is used for U.S. citizens or national children under 18 in California to provide an affidavit of identity.

This Form is used for submitting an Affidavit of Identity for U.S. Citizen or National Children Under 18 in California, specifically designed for Armenian speakers.

This form is used for U.S. citizen or national children under 18 in California, who need to provide an affidavit of identity. The form is available in Korean language.

This form is used for Russian-speaking U.S. citizens or national children under 18 residing in California to provide an affidavit of identity.

This form is used for U.S citizens or national children under 18 residing in California who need to provide an affidavit of identity. The form is available in Chinese language.

This form is used for assessing the health of children aged 5-8 years in California. It is available in both English and Arabic languages.

This Form is used for assessing the health of children aged 9-11 years in California. It is available in both English and Arabic.

This form is used for conducting a Staying Healthy Assessment for children between the ages of 12-17 in California. It is available in English and Arabic.

This form is used for the Staying Healthy Assessment for children between the ages of 12-17 in California. The form is available in both English and Chinese.

This form is used for providing proof of acceptable citizenship or identity documents in California. It is particularly available in Tagalog language.

This form is used for providing additional income and property information needed for Medi-Cal in California. It is available in Chinese.

This document is a form used in California's Medi-Cal program to collect additional information about income and property. It is available in Arabic.

This Form is used for doctors to verify the eligibility of individuals for Home and Community Based Services under the spousal impoverishment provisions in California.

This form is used for doctors to verify the need for home and community based services for individuals in California who are applying for spousal impoverishment provisions. It specifically includes a version in Cambodian language.

This document is used to verify income in the form of housing or other in-kind benefits. It is a supplement to the MC 210 Statement of Facts and is specifically for residents of California. It is available in both English and Spanish.

This form is used for authorizing the release of protected health information and confidential information in the state of California.

This Form is used for keeping track of designated facilities in California that handle individuals detained for involuntary psychiatric evaluation (also known as 5150). It helps to maintain accurate inventory information for regulatory purposes.

This document is used for providers in California who want to participate in the Medi-Cal Ground Emergency Medical Transportation Services (GEMT) Supplemental Reimbursement Program. It outlines the terms and conditions for participation in the program.