A

Applicant refuses to assign rights for third party insurance.

F

Disabled/blind child living overseas, ineligible for Medi-Cal, and living with a parent who is a member of the military.

N

Third party liability does not exist.

R

Applicant refuses to cooperate in providing third party liability data. Ineligi- ble for Medi-Cal.

Y

Third party liability does exist and applicant agrees to assign rights.

“Blank

Not Applicable