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Referral Date: Case Name: Case #: Child's Name: DOB Female Male SSN#:Medical Yes Nonmedical #: Effective Date: Copy of Medical card must Ethnicity: Primary language: Other Languages: be attached to
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Medi-Cal is California's Medicaid program that provides free or low-cost health coverage for eligible individuals and families with limited income and resources.
Individuals and families with limited income and resources who meet the eligibility criteria are required to file for Medi-Cal.
You can fill out the Medi-Cal application online, in person, by mail, or over the phone. The application requires you to provide information about your income, household size, and other relevant details.
The purpose of Medi-Cal is to ensure that low-income individuals and families have access to essential health care services, including doctor visits, hospital care, prescription medications, and preventive care.
You must report information about your income, household size, citizenship or immigration status, and any other relevant details that may affect your eligibility for Medi-Cal.
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