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FOOMKA & NIDAAMKA

U DIIDO ADEEGYADA KOOWAAD EE KOOWAAD

  1. PATIENT REGISTRATION FORM- ENGLISH or SPANISH and ADD A MINOR PATIENT REGISTRATION FORM ENGLISH or SPANISH (to add any minors you are also registering) OR, if you are only registering minors you are the parent/guardian of and not yourself: 
    MINORS ONLY PATIENT REGISTRATION FORM – ENGLISH OR SPANISH
    and ADD A MINOR PATIENT REGISTRATION FORM ENGLISH OR SPANISH (to add additional minors if necessary)

  2. HEALTH INFORMATION RELEASE FORM- ENGLISH or SPANISH

  3. BEHAVIORAL HEALTH CONSENT FORM - ENGLISH or SPANISH

  4. ITEMS LISTED IN THE ENROLLMENT VISIT CHECKLIST

  5. FOR DENTAL APPOINTMENT ONLY- DENTAL HEALTH HISTORY

HADDII aadan awoodin inaad keento-jeegag cadeyn dakhli ah, fadlan buuxi:

EMPLOYEE INCOME VERIFICATION FORM (your employer must fill out) 

AMA

SELF-EMPLOYMENT LEDGER (if you are self-employed) - ENGLISH or SPANISH 

Haddii aad xiiseyneyso qorshe caymis caafimaad iyada oo loo marayo Connect for Health Colorado oo adiga (ama saygaaga / xaaskaaga) lagu siiyo caymiska caafimaadka loo-shaqeeyaha, fadlan buuxi QAADKA SHAQAALAHA SHAQAALAHA

DAAWEYNTA AAD 

Dhammaan carruurta da'doodu ka yar tahay 18 jir waa in ay la socdaan waalid ama mas'uul sharci ah marka ay booqanayaan Salud markii ugu horeysay iyo hal mar sannadkii ka dib.

Waxaan fahamsanahay in waalidiinta ama dadka mas'uulka ah aysan mar walba diyaar u ahayn inay keenaan carruurtooda waxaana laga yaabaa inay doonayaan inay u oggolaadaan ilmo inuu booqdo kaligiis ama qof weyn. Salud waxay u ogolaaneysaa caruurta da'doodu tahay 13 jir iyo ka weyn inay booqdaan kali-socodka. Waalidka ama masuulka sharciga ah ayaa u oggolaan kara tan kahor imaanshaha booqashada adoo buuxinaya foomamka oggolaanshaha ee hoose.

  • AUTHORIZATION FOR A MINOR TO BE ACCOMPANIED BY SOMEONE OTHER THAN A PARENT/GUARDIAN - ENGLISH or SPANISH

  • AUTHORIZATION FOR TREATMENT OF A MINOR WITHOUT A PARENT/GUARDIAN PRESENT - ENGLISH or SPANISH

SALUD FOOMKA GUUD & XEERARKA 

SIYAASADDA SIRTA- waxay sharraxaysaa sida Salud u ilaaliyo macluumaadkaaga caafimaad

OGOLAANSHAHA DAWEYNTA - macluumaad kusaabsan daahid & siyaasad balan balineed iyo siyaasada maaliyadeed

SALUD WAA GURIGAAGA CAAFIMAAD- wuxuu qeexayaa sida Salud ugu adeego sida Gurigaaga Caafimaadka

XUQUUQDA BUKAANKA & MAS'UULIYADAHA- wuxuu qeexayaa xuquuqda iyo mas'uuliyadaha bukaanka Salud

MACLUUMAADKA TALLAALKA KA BAXA - si aad macluumaadkaaga tallaalka uga saarto ilmahaaga/ilmahaaga

  Nidaamka Macluumaadka Tallaalka Colorado

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