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CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.100 Medical Services Board

50 5) The school record shows the name(s) and place(s) of birth of the applicant's parents. xvii) Federal or State census record showing U.S. citizenship or a U.S. place of birth and the applicant's age. xviii) One of the following documents that shows a U.S. place of birth and was created at least 5 years before the application for The Medical Assistance Program. For children under 16 the document must have been created near the time of birth or at least 5 years before the date of application. 1) Seneca Indian tribal census record; 2) Bureau of Indian Affairs tribal census records of the Navajo Indians; 3) U.S. State Vital Statistics official notification of birth registration; 4) A delayed U.S. public birth record that is recorded more than 5 years after the person's birth; 5) Statement signed by the physician or midwife who was in attendance at the time of birth; or 6) The Roll of Alaska Natives maintained by the Bureau of Indian Affairs. xix) Institutional admission papers from a nursing facility, skilled care facility or other institution created at least 5 years before the initial application date that indicate a U.S. place of birth. xx) Medical (clinic, doctor, or hospital) record. 1) The record shall have been created at least 5 years before the initial application date; and 2) The record shall indicate a U.S. place of birth.