Daim Foos Kev Xa Mus Rau Cov Tswvcuab Ntawm Pab Pawg Kws Tswj Kev Tu Xyuas Uas Muaj Kev Txhim Kho Rau Cov Neeg Laus (21 xyoos thiab tshaj ntawd)
For adult referrals to Enhanced Care Management (ECM) Services.
Kev Pab Cuam Saum Ooslais (Online)
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Xaiv Koj Tus Kws Kho mob
Thov sau tiav daim foos Xaiv Ib Tus Thawj Kws Kho Mob saum oos lais ces Lub Chaw Pab Cuam Tswvcuab mamli xyuas koj txoj kev thov.
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Zej Zog Kev Pab Txhawb: Daim Ntawv Foos Xa Mus Xyuas Seb Puas Muaj Feem thiab Nyob Tau Tom Tsev (Environmental Accessibility and Adaptability; EAA, raws li sau hauv lus Askiv) Rau Tswvcuab
Rau cov kev xa mus txais kev pab cuam los ntawm Zej Zog Kev Pab Txhawb.
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Zej Zog Kev Pab Txhawb: Daim Ntawv Foos Xa Mus Txais Zaub Mov Noj Rau Tswvcuab
For meals member referrals to Community Support services.
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Zej Zog Kev Pab Txhawb: Daim Ntawv Foos Xa Mus Txais Kev Pab Vaj Tsev Nyob Rau Tswvcuab
For member housing referrals to Community Support services.
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Cov Kev Pab Txhawb Hauv Zej Zog: Cov Kev Pab Cuam Tu Neeg Thiab Tu Tsev thiab Kev Pab Cuam Rau Kev So Ib Vuag rau Cov Neeg Saib Xyuas txog ntawm Kev Xa Mus Rau Kws Kho Mob Pab Saib Xyuas
For Personal Care and Homemaker Services and Respite Services referrals to Community Support services.
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Daim Foos Thov Kom Xa Cov Ntawv Txwv Tsis Pub Lwm Tus Paub Rau Lwm Txoj Kev Sib Txuas Lus
Koj tuaj yeem ua tiav daim foos no los thov kom cov ntawv txwv tsis pub lwm tus paub uas muaj cov lus qhia txog koj li kev mob nkeeg raug muab xa mus rau lwm qhov chaw nyob, lwm tus email xa ntawv, lossis lwm tus xov tooj.
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Daim Ntawv Ua Hais Kev Tsis Txaus Siab
Lub Alliance mamli lees txais koj txoj kev tsis txaus siab lossis kev thov kom rov qab txiav txim dua los ntawm kev xa ntawv tuaj rau koj yam tsis pub dhau tsib (5) hnub, thiab peb mamli teb koj txoj kev tsis txaus siab lossis kev thov kom rov qab txiav txim dua yam tsis pub dhau peb caug (30) hnub.
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Kev Nthuav Tawm Ntaub Ntawv
Cov Kws Pab Kho Mob thiab Cov Koom Haum Uas Koom Tes Hauv Zej Zog tuaj yeem siv tau daim foos no los thov kom lub Alliance qhia tawm cov ntaub ntawv uas qhia txog ib tus Alliance tswvcuab uas raug pom tias ntaub ntawv kuaj mob nkeeg txwv tsis pub qhia tawm yog tsis tau kev tso cai (protected health information; PHI, raws li sau hauv lus Askiv).
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Cov Lus Qhia Txog Kev Fajseeb Kho Mob
Yog hais tias koj muaj Medi-Cal thiab lwm yam kev fajseeb kho mob, koj yuav tsum tau hloov kho tshiab koj lwm yam kev fajseeb kho mob li ntaub ntawm txhua zaus uas nws hloov.
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Daim Foos Thov Them Nyiaj Rov Qab Rau Tswvcuab
Sau tiav Daim Ntawv Foos Thov Them Nyiaj Rov Qab Rau Tus Tswvcuab los thov them nyiaj rov qab rau cov kev pab kho mob uas raug pab them rau. Yog koj muaj lus nug, hu rau Lub Chaw Pab Tswvcuab ntawm (800) 700-3874.
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Non-Emergency Medical Transportation Minor Consent Form
This form should be completed by a parent or guardian to consent to non-emergency medical transportation for a minor.
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Thov Rau Ib Daim Npav ID, Ib Phau Ntawv Rau Tus Tswvcuab thiab Ib Phau Ntawv Teev Npe Cov Kws Kho Mob
Lub Alliance tuaj yeem xa tau ib Daim Alliance Tswvcuab Npav ID, Ib Phau Ntawv Rau Tus Tswvcuab lossis Ib Phau Ntawv teev Npe Cov Kws Kho Mob. Tej zaum nws yuav siv sijhawm li 10 hnub ua haujlwm los txais tau cov ntaub ntawv uas koj tau thov rau.
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Cov Lus Thov Txwv Tsis Pub Lwm Tus Paub
Koj tuaj yeem thov rau ib qho kev txwv tsis pub lwm tus paub txog koj lossis koj li ntaub ntawv kho mob yog hais tias koj xav tau ib daim ntawv luam txog koj li kev kho mob cov ntaub ntawv lossis xav txwv txoj kev koj li kev kho mob cov ntaub ntawv raug qhia tawm nrog lwm cov koom haum.
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Kev Thov Rau Tus Neeg Sawv Cev Rau Koj
Mus sau tiav daim foos no los thov rau ib tus neeg sawv cev rau koj. Koj tuaj yeem xaiv tau ib tus neeg sawv cev rau koj los txiav txim txog koj li kev kho mob yam sawv cev rau koj.
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Kev Hloov Kho Dua Tshiab Tus Kheej Cov Ntaub Ntawv Tiv Tauj
Yog hais tias koj li chaw nyob lossis xov tooj tau hloov, koj yuav tau tiv tauj rau lub Alliance thiab koj lub cheeb nroog Medi-Cal lub chaw ua haujlwm los hloov koj cov ntaub ntawv tiv tauj.
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Daim Ntawv Thov Nkag Qhov Kev Npaj Kho Mob Rau Cov Menyuam Yaus Pab Neeg Tawm Tswvyim Los Pab Cov Tsev Neeg
Qhov Kev Npaj Kho Mob Rau Cov Menyuam Yaus Pab Neeg Tawm Tswvyim Los Pab Cov Tsev Neeg (Whole Child Model Family Advisory Committee; WCMFAC, raws li sau hauv lus Askiv) sawv cev rau cov kev xav tau thiab cov kev txhawj xeeb los ntawm cov tsev neeg uas muaj cov menyuam yaus uas tsim nyog tau txais-CCS. Sau tiav daim foos no los thov nkag pab neeg tawm tswvyim.
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Daim Foos Hais Txog Kev Xa Mus Rau Kws Kho Mob Rau Cov Hluas Ntawm Pab Pawg Kev Txhim Khu Kev Pab Tswj Kev Tu Xyuas (20 xyoos thiab yau dua)
For youth referrals to Enhanced Care Management (ECM) Services.
