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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHCS4073
for the current year.
Form DHCS4073 Pre-enrollment Application - California (Hmong)
This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California.
The document is provided in Hmong. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DHCS4073?A: Form DHCS4073 is a pre-enrollment application specifically for residents of California who speak Hmong.
Q: What is the purpose of Form DHCS4073?A: The purpose of Form DHCS4073 is to apply for enrollment in healthcare programs in California for individuals who speak Hmong.
Q: Who can use Form DHCS4073?A: Form DHCS4073 can be used by individuals who speak Hmong and are residents of California.
Q: Is the Form DHCS4073 available in English?A: No, the Form DHCS4073 is specifically available in Hmong language only.
Q: What information is required on Form DHCS4073?A: Form DHCS4073 requires information such as personal details, income, household size, and other relevant information for enrollment purposes.
Q: What healthcare programs can I apply for using Form DHCS4073?A: By submitting Form DHCS4073, you can apply for various healthcare programs offered by the state of California, such as Medi-Cal.
Q: Are there any fees associated with submitting Form DHCS4073?A: No, there are no fees associated with submitting Form DHCS4073.
Q: What should I do if I need help filling out Form DHCS4073?A: If you need assistance in filling out Form DHCS4073, you can contact the California Department of Health Care Services (DHCS) or seek help from a qualified enrollment professional.
Form Details:
- Released on November 1, 2007;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a printable version of Form DHCS4073 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
