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Form Dhcs 0004 - California Request For California Birth Record (Hmong) - Health And Human Services Agency

State of California – Health and Human Services Agency

Department of Health Care Services

Daim Ntawv Thov Ntawv Yug hauv Kalifonias

Medi-Cal yuav nrhiav tau cov ntawv yug rau cov tibneeg uas yug hauv Kalifonias — tsis yog nrhiav tau dawb!

Hnub no yog hnubtim:

Hlis:

Hnub:

Xyoo:

Cov kev qhia:

• Ua daim ntawv no. Ntaus

Tus neeg uas ua daim ntawv no:

Npe:

Npe nrab:

Xeem:

lossis sau tej tus tsiaj

ntawv. Koj siv tau tej kev

Koj xav tau leejtwg daim ntawv yug?

qhia hauv daim copy

Lub npe hauv daim ntawv yug:

ntawm daim ntawv yug los

Npe:

Npe nrab:

Xeem:

ua daim ntawv no.

Yog tus neeg no raug lwm tus yuav

• Nqa lossis xa daim

coj mus tu, sau lub npe/xeem tshiab:

Npe:

Npe nrab:

Xeem:

ntawv ua tas lawm no

mus rau lub chaw

Yog:

Tub

Ntxhais

pabcuam pejxeem hauv

koj lub nroog.

Hnub yug:

Hlis:

Hnub:

Xyoo:

• Yog koj ua tsis tau daim

Lub Nroog thiab County uas yug:

ntawv no, hu mus rau lub

Nroog :

County hauv Kalifonias:

chaw pabcuam pejxeem

Leej niam lub npe:

Npe:

Npe nrab:

Xeem:

hauv koj lub nroog.

Tej zaum peb yuav nrhiav

Leej txiv lub npe:

Npe:

Npe nrab:

Xeem:

tsis tau daim ntawv yug uas

koj xav tau. Yog muaj li no,

Tus Lej Daim Ntawv Yug #

(yog paub):

koj yuav tau muab lwm yam

puavpheej uas qhia tau tias

yog neeg Amelikas.

Tus ntxiv uas koj xav tau

daim ntawv yug:

Npe:

Npe nrab:

Xeem:

Yog peb nrhiav tau daim

ntawv yug lawm, los koj

Yog tus neeg no raug lwm tus yuav

yuav tau muab tej

coj mus tu, sau lub npe/xeem tshiab:

Npe:

Npe nrab:

Xeem:

puavpheej uas qhia tias yog

leejtwg tiag.

Yog:

Tub

ntxhias

Lub

county

lub chaw pabcuam

pejxeem xav tau cov kev qhia no

Hnub yug:

Hlis:

Hnub:

Xyoo:

los nrhiav daim ntawv yug hauv

Kalifonias los qhia tias yog neeg

Lub Nroog thiab County uas yug:

Nroog:

County hauv Kalifonias:

Amelikas tiag. Koj tsis muab cov

kev qhia no los tau.Tabsis yog koj

Leej niam lub npe:

Npe:

Npe nrab:

Xeem:

tsis muab, tej zaum lub

county

yuav tsis muaj peevxwm nrhiav

Leej txiv lub npe:

Npe:

Npe nrab:

Xeem:

tau koj daim ntawv yug.

Tus Lej Daim Ntawv Yug #

(yog paub):

Yog koj xav tau ntau tshaj li ob daim ntawv yug, ua ib daim ntawv thov ntxiv.

DHCS 0004 (06/07) – Hmong

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Form Dhcs 0004 - California Request For California Birth Record (Hmong) - Health And Human Services Agency

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