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Medi-Cal (MEDI-CAL REQUEST FOR INFORMATION) (Department of Health Care Services)

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State of California—Health and Human Services Agency Department of Health Care Services

Medi-Cal Program

 Medi-Cal (MEDI-CAL REQUEST FOR INFORMATION)

MC 355 TAI (Rev.07/18)

:

 :

:

 :

 :

 :

:

:

:  

 



Medi-Cal 

            

       

     





     Medi-Cal !

•  

•  

•  



•   

•   

• 

 

MC 355 TAI (Rev.07/18)





 !   

 !     

   



      

    





Medi-Cal (MEDI-CAL REQUEST FOR INFORMATION)

:  เฉพา



  

 

   Medi-Cal 

  Covered California    

                 



      

   



:

   

:

          

    

•

   :

•   

  



 Schedule C 

 :

   –  

   :

     

 –   :

   –  

 

MC 355 TAI (Rev.07/18)

    –  

   :

    (

“Request for Tax Household Information)

(RFTHI)” :

:

 

            

:













Medi-Cal



California

 

 :

:

  

 



  



 

 

 

 18 

    18 

:







   

MC 355 TAI (Rev.07/18)

  

  



  

(  ) :

  

  

   United States  

    



  

    12 



 Medi-Cal 





 

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Medi-Cal (MEDI-CAL REQUEST FOR INFORMATION) (Department of Health Care Services)

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Completed 30 July 2020

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