STATE OF CALIFORNIA DEPARTMENT OF SOCIAL WELFARE
IDENTIFICATION CARD
THIS CARD IS PROVIDED FOR THE PURPOSE OF ESTABLISHING ELIGIBILITY FOR MEDICAL CARE UNDER THE MEDICAL
ASSISTANCE PROGRAM. THE NAMES OF THOSE ELIGIBLE
ARE LISTED BELOW.
ISSUED BY L.A. COUNTY TO
GP
DIST.
,'HRIA HYUN
933 MALTMAN
AVE NO 1
LOS ANGELES CALIF
19-10-0505241-1-01
37
CASE NO. ISSUED AND VALID
ONLY FOR PERIOD SHOWN. r
IF CHECKED, ELIGIBLE CLIENT IS RESPONSIBLE FOR A SHARE'
OF THE COST OF SUCH CARE.
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