{"id":26268,"date":"2024-09-11T16:20:15","date_gmt":"2024-09-11T20:20:15","guid":{"rendered":"https:\/\/www.elderplan.org\/?page_id=26268"},"modified":"2024-11-13T15:39:58","modified_gmt":"2024-11-13T20:39:58","slug":"physician","status":"publish","type":"page","link":"https:\/\/www.elderplan.org\/es\/for-providers\/become-a-provider\/physician\/","title":{"rendered":"Solicitud para convertirse en m\u00e9dico"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f28596-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"28596\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/26268#wpcf7-f28596-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-no-moving-animation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"28596\"><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\"><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\"><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f28596-o1\"><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\"><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\"><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\"><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\"><input type=\"hidden\" name=\"_wpcf7cf_options\" value='{\"form_id\":28596,\"conditions\":[{\"then_field\":\"contact_address_group\",\"and_rules\":[{\"if_field\":\"contact_same_address_as_above\",\"operator\":\"is empty\",\"if_value\":\"\"}]}],\"settings\":{\"animation\":\"yes\",\"animation_intime\":200,\"animation_outtime\":200,\"conditions_ui\":\"normal\",\"notice_dismissed\":false,\"notice_dismissed_update-cf7-5.9.8\":true,\"notice_dismissed_update-cf7-6.0\":true,\"notice_dismissed_update-cf7-6.0.1\":true,\"notice_dismissed_update-cf7-6.0.2\":true,\"notice_dismissed_update-cf7-6.0.3\":true,\"notice_dismissed_update-cf7-6.0.6\":true,\"notice_dismissed_update-cf7-6.1.1\":true,\"notice_dismissed_update-cf7-6.1.4\":true,\"notice_dismissed_update-cf7-6.1.5\":true}}'><input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.5\"><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\">\n<\/fieldset>\n<div class=\"padding-interior\">\n\t<div class=\"max-width-wrap\">\n\t\t<h2 class=\"font-40 mb-16\">\u00danase a la red de proveedores de Elderplan\n\t\t<\/h2>\n\t\t<p class=\"mb-16\">Por favor, complete el formulario de solicitud de participaci\u00f3n en su totalidad. Una vez revisemos su solicitud, un Representante de Proveedores de Elderplan se estar\u00e1 comunicando con usted dentro de un plazo de hasta 60 d\u00edas. Si tiene alguna consulta, no dude en comunicarse con nuestro equipo de servicio al cliente al <a href=\"tel:+17189217979\">718-921-7979<\/a>.\n\t\t<\/p>\n\t\t<p class=\"mb-32\"><strong>Este formulario es para proveedores que actualmente no tienen contrato con Elderplan.<\/strong> Si ya forma parte de la red de proveedores de Elderplan o se une a un grupo que ya pertenece a nuestra red, comun\u00edquese con nuestro departamento de servicios para proveedores al <a href=\"tel:+17189217979\">718-921-7979<\/a>\n\t\t<\/p>\n\t\t<div class=\"box box--top box--top-sharp\">\n\t\t\t<h3 class=\"form-section-heading\">Informaci\u00f3n general\n\t\t\t<\/h3>\n <!-- Group Section -->\n\t\t\t<p><label>\u00bfEs parte de un grupo?*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"group_part_of_group\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"group_part_of_group\" value=\"S\u00ed\"><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"group_part_of_group\" value=\"No\" checked><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span><!-- Conditional Section for Group Information -->\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<div class=\"group-green-box-lt\">\n\t\t\t\t<p><label>Nombre del grupo\/pr\u00e1ctica*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"group_practice_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"group_practice_name\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p><label>N\u00famero de Identificaci\u00f3n Fiscal (TIN) de la Organizaci\u00f3n*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"group_tin\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"group_tin\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p class=\"small-cf7 input-help mb-24\">Este es un n\u00famero obligatorio de 9 d\u00edgitos.\n\t\t\t\t<\/p>\n\t\t\t\t<p><label>Tipo de pr\u00e1ctica*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"practice_type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"practice_type\" value=\"PC\" checked><span class=\"wpcf7-list-item-label\">PC<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"practice_type\" value=\"LLC\"><span class=\"wpcf7-list-item-label\">LLC<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"practice_type\" value=\"IPA\"><span class=\"wpcf7-list-item-label\">IPA<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"practice_type\" value=\"FQHC\"><span class=\"wpcf7-list-item-label\">FQHC<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\n <!-- Provider Section using Repeater -->\n\t\t<div class=\"box box--top box--top-sharp\">\n\t\t\t<p class=\"mb-16\"><span class=\"font-22\">Informaci\u00f3n de los proveedores<\/span>Agregue al menos un proveedor\n\t\t\t<\/p>\n\t\t\t<div data-wpcf7-group-id=\"providers\" id=\"providers-group\" tabindex=\"1\" class=\"wpcf7-field-groups \">\n\t\t\t\t<div class=\"wpcf7-field-group\">\n\t\t\t\t\t<div class=\"box\">\n\t\t\t\t\t\t<p><label>Nombre*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"provider_first_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"provider_first_name\"><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<p><label>Apellido*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"provider_last_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"provider_last_name\"><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<p><label>Identificador de proveedor nacional (NPI) individual*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"provider_npi\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"provider_npi\"><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<p>Este es un n\u00famero obligatorio de 10 d\u00edgitos.\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<p><label>Select Specialty*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"provider_specialty\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"provider_specialty\"><option value=\"Acupuntura\">Acupuntura<\/option><option value=\"Medicina de la adicci\u00f3n\">Medicina de la adicci\u00f3n<\/option><option value=\"Psiquiatr\u00eda\n       de la adicci\u00f3n\">Psiquiatr\u00eda\n       de la adicci\u00f3n<\/option><option value=\"Medicina del adolescente\">Medicina del adolescente<\/option><option value=\"Alergia e inmunolog\u00eda\">Alergia e inmunolog\u00eda<\/option><option value=\"Anestesiolog\u00eda\">Anestesiolog\u00eda<\/option><option value=\"Enfermedad cardiovascular\">Enfermedad cardiovascular<\/option><option value=\"Quiropr\u00e1ctica\">Quiropr\u00e1ctica<\/option><option value=\"Electrofisiolog\u00eda card\u00edaca cl\u00ednica\">Electrofisiolog\u00eda card\u00edaca cl\u00ednica<\/option><option value=\"Citogen\u00e9tica Cl\u00ednica\">Citogen\u00e9tica Cl\u00ednica<\/option><option value=\"Gen\u00e9tica cl\u00ednica\">Gen\u00e9tica cl\u00ednica<\/option><option value=\"Neurofisiolog\u00eda cl\u00ednica\">Neurofisiolog\u00eda cl\u00ednica<\/option><option value=\"Trabajo social cl\u00ednico\">Trabajo social cl\u00ednico<\/option><option value=\"Cirug\u00eda colorrectal\">Cirug\u00eda colorrectal<\/option><option value=\"Medicina de atenci\u00f3n intensiva\">Medicina de atenci\u00f3n intensiva<\/option><option value=\"Dermatolog\u00eda\">Dermatolog\u00eda<\/option><option value=\"Dietista\/nutricionista\">Dietista\/nutricionista<\/option><option value=\"Endocrinolog\u00eda, diabetes y metabolismo\">Endocrinolog\u00eda, diabetes y metabolismo<\/option><option value=\"Epilepsia\">Epilepsia<\/option><option value=\"Medicina familiar\">Medicina familiar<\/option><option value=\"Medicina p\u00e9lvica femenina y cirug\u00eda reconstructiva\">Medicina p\u00e9lvica femenina y cirug\u00eda reconstructiva<\/option><option value=\"Gastroenterolog\u00eda\">Gastroenterolog\u00eda<\/option><option value=\"Cirug\u00eda vascular general\">Cirug\u00eda vascular general<\/option><option value=\"Medicina geri\u00e1trica\">Medicina geri\u00e1trica<\/option><option value=\"Psiquiatr\u00eda\">Psiquiatr\u00eda<\/option><option value=\"Oncolog\u00eda ginecol\u00f3gica\">Oncolog\u00eda ginecol\u00f3gica<\/option><option value=\"Cirug\u00eda de la mano\">Cirug\u00eda de la mano<\/option><option value=\"Hematolog\u00eda\">Hematolog\u00eda<\/option><option value=\"Cuidados paliativos y de hospicio\">Cuidados paliativos y de hospicio<\/option><option value=\"Infectolog\u00eda\">Infectolog\u00eda<\/option><option value=\"Medicina interna\">Medicina interna<\/option><option value=\"Cardiolog\u00eda intervencionista\">Cardiolog\u00eda intervencionista<\/option><option value=\"Medicina materno-fetal\">Medicina materno-fetal<\/option><option value=\"Oncolog\u00eda m\u00e9dica\">Oncolog\u00eda m\u00e9dica<\/option><option value=\"Toxicolog\u00eda M\u00e9dica\">Toxicolog\u00eda M\u00e9dica<\/option><option value=\"Nefrolog\u00eda\">Nefrolog\u00eda<\/option><option value=\"Discapacidades del neurodesarrollo\">Discapacidades del neurodesarrollo<\/option><option value=\"Cirug\u00eda neurol\u00f3gica\">Cirug\u00eda neurol\u00f3gica<\/option><option value=\"Neurolog\u00eda\">Neurolog\u00eda<\/option><option value=\"Neurolog\u00eda con cualificaciones especiales en neurolog\u00eda infantil\">Neurolog\u00eda con cualificaciones especiales en neurolog\u00eda infantil<\/option><option value=\"Medicina neuromuscular\">Medicina neuromuscular<\/option><option value=\"Neurorradiolog\u00eda\">Neurorradiolog\u00eda<\/option><option value=\"Neurotolog\u00eda\">Neurotolog\u00eda<\/option><option value=\"Medicina nuclear\">Medicina nuclear<\/option><option value=\"Radiolog\u00eda nuclear\">Radiolog\u00eda nuclear<\/option><option value=\"Enfermero practicante\">Enfermero practicante<\/option><option value=\"Enfermera-Matrona\">Enfermera-Matrona<\/option><option value=\"Obstetricia y ginecolog\u00eda\">Obstetricia y ginecolog\u00eda<\/option><option value=\"Medicina ocupacional\">Medicina ocupacional<\/option><option value=\"Terapia ocupacional\">Terapia ocupacional<\/option><option value=\"Oftalmolog\u00eda\">Oftalmolog\u00eda<\/option><option value=\"Cirug\u00eda oral\">Cirug\u00eda oral<\/option><option value=\"Medicina ortop\u00e9dica deportiva\">Medicina ortop\u00e9dica deportiva<\/option><option value=\"Cirug\u00eda Ortop\u00e9dica\">Cirug\u00eda Ortop\u00e9dica<\/option><option value=\"Osteopathic Manipulative Medicine\">Osteopathic Manipulative Medicine<\/option><option value=\"Otorrinolaringolog\u00eda\">Otorrinolaringolog\u00eda<\/option><option value=\"Manejo del dolor\">Manejo del dolor<\/option><option value=\"Patolog\u00eda\">Patolog\u00eda<\/option><option value=\"Medicina f\u00edsica y rehabilitaci\u00f3n\">Medicina f\u00edsica y rehabilitaci\u00f3n<\/option><option value=\"Fisioterapia\">Fisioterapia<\/option><option value=\"Auxiliar M\u00e9dico\">Auxiliar M\u00e9dico<\/option><option value=\"Cirug\u00eda pl\u00e1stica\">Cirug\u00eda pl\u00e1stica<\/option><option value=\"Podiatr\u00eda\">Podiatr\u00eda<\/option><option value=\"Enfermera Practicante de Psiquiatr\u00eda\">Enfermera Practicante de Psiquiatr\u00eda<\/option><option value=\"Psiquiatr\u00eda\">Psiquiatr\u00eda<\/option><option value=\"Psicolog\u00eda\">Psicolog\u00eda<\/option><option value=\"Medicina Psicosom\u00e1tica\">Medicina Psicosom\u00e1tica<\/option><option value=\"Salud p\u00fablica y medicina preventiva general\">Salud p\u00fablica y medicina preventiva general<\/option><option value=\"Enfermedades pulmonares\">Enfermedades pulmonares<\/option><option value=\"Oncolog\u00eda radioter\u00e1pica\">Oncolog\u00eda radioter\u00e1pica<\/option><option value=\"F\u00edsica Radiol\u00f3gica\">F\u00edsica Radiol\u00f3gica<\/option><option value=\"Radiolog\u00eda\">Radiolog\u00eda<\/option><option value=\"Reumatolog\u00eda\">Reumatolog\u00eda<\/option><option value=\"Medicina del sue\u00f1o\">Medicina del sue\u00f1o<\/option><option value=\"Asistente Especialista\">Asistente Especialista<\/option><option value=\"Patolog\u00eda del habla y del lenguaje\">Patolog\u00eda del habla y del lenguaje<\/option><option value=\"Medicina de lesiones de la m\u00e9dula espinal\">Medicina de lesiones de la m\u00e9dula espinal<\/option><option value=\"Medicina deportiva\">Medicina deportiva<\/option><option value=\"Cirug\u00eda\">Cirug\u00eda<\/option><option value=\"Medicina de atenci\u00f3n intensiva quir\u00fargica\">Medicina de atenci\u00f3n intensiva quir\u00fargica<\/option><option value=\"Oncolog\u00eda quir\u00fargica\">Oncolog\u00eda quir\u00fargica<\/option><option value=\"Cirug\u00eda tor\u00e1cica\">Cirug\u00eda tor\u00e1cica<\/option><option value=\"Hepatolog\u00eda y trasplante\">Hepatolog\u00eda y trasplante<\/option><option value=\"Urolog\u00eda\">Urolog\u00eda<\/option><option value=\"Radiolog\u00eda vascular e intervencionista\">Radiolog\u00eda vascular e intervencionista<\/option><option value=\"Neurolog\u00eda vascular\">Neurolog\u00eda vascular<\/option><\/select><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<p><label>Correo electr\u00f3nico*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"provider_email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"provider_email\"><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<p><label>\u00bfEste proveedor realiza visitas domiciliarias?*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"provider_home_visits\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"provider_home_visits\" value=\"S\u00ed\" checked><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"provider_home_visits\" value=\"No\"><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<p><button type=\"button\" class=\"wpcf7-field-group-remove \">-<\/button><button type=\"button\" class=\"wpcf7-field-group-add \">+<\/button><input type=\"hidden\" class=\"wpcf7-field-group-count\" name=\"_wpcf7_groups_count[providers]\" value=\"1\">\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<p>Use los botones m\u00e1s y menos para agregar y quitar proveedores\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"box\">\n\t\t\t<p class=\"mb-16\"><span class=\"font-22\">Direcci\u00f3n de la pr\u00e1ctica<\/span>\n\t\t\t<\/p>\n <!-- Practice Address Section -->\n\t\t\t<p><label>Direcci\u00f3n*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"practice_street_address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"practice_street_address\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p><label>Direcci\u00f3n 2<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"practice_street_address_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"practice_street_address_2\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p><label>Ciudad*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"practice_city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"practice_city\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p><label>Estado*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"practice_state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"practice_state\"><option value=\"New York\">New York<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p><label>C\u00f3digo Postal*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"practice_zip\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"practice_zip\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p><label>N\u00famero de tel\u00e9fono*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"practice_phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"practice_phone\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-32\">\n\t\t\t<\/div>\n\t\t\t<p class=\"small-cf7 input-help mb-24\">Este es un n\u00famero de tel\u00e9fono obligatorio de 10 d\u00edgitos.\n\t\t\t<\/p>\n\t\t\t<p class=\"font-22\">\u00bfA qui\u00e9n debemos contactar si tenemos alguna duda?\n\t\t\t<\/p>\n <!-- Contact Section -->\n\t\t\t<p><label>Nombre completo*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_full_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact_full_name\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p><label>Correo electr\u00f3nico de contacto*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"contact_email\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p><label>La misma direcci\u00f3n que la anterior<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_same_address_as_above\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"contact_same_address_as_above[]\" value=\"S\u00ed\" checked><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n <!-- Conditional Contact Address Section -->\n\t\t\t<div data-id=\"contact_address_group\" data-orig_data_id=\"contact_address_group\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t<p><label>Direcci\u00f3n*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_street_address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact_street_address\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p><label>Direcci\u00f3n 2<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_street_address_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact_street_address_2\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p><label>Ciudad*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact_city\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p><label>Estado*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"contact_state\"><option value=\"New York\">New York<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p><label>C\u00f3digo Postal*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_zip\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact_zip\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p><label>N\u00famero de tel\u00e9fono*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"contact_phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"contact_phone\"><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t\t<p class=\"small-cf7 input-help mb-24\">Este es un n\u00famero de tel\u00e9fono obligatorio de 10 d\u00edgitos.\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<span class=\"wpcf7-form-control-wrap your-unique-id\" data-name=\"your-unique-id\"><input type=\"hidden\" name=\"your-unique-id\" class=\"wpcf7-form-control wpcf7-hidden wpcf7dtx wpcf7dtx-hidden\" aria-invalid=\"false\" value=\"4A82043C-0357-4F39-B595-B0B9E1128C5C\"><\/span>\n\n <!-- Submit Button -->\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enviar Formulario de Solicitud de Participaci\u00f3n\">\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"screen-reader-response\">\n\t<div role=\"status\">\n\t<\/div>\n<\/div><input type=\"hidden\" class=\"wpcf7-pum\" value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}'><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"{:en} Join Elderplan\u2019s Provider Network Please fill out the participation request form completely. After we review your request, an Elderplan Provider Representative will contact you within 60 days. For any [...]","protected":false},"author":21,"featured_media":0,"parent":60,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-26268","page","type-page","status-publish","hentry"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"es","enabled_languages":["en","es","zh"],"languages":{"en":{"title":true,"content":true,"excerpt":false},"es":{"title":true,"content":true,"excerpt":false},"zh":{"title":true,"content":true,"excerpt":false}}},"acf":[],"jetpack_sharing_enabled":true,"publishpress_future_action":{"enabled":false,"date":"2026-04-12 15:51:52","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages\/26268","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/comments?post=26268"}],"version-history":[{"count":0,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages\/26268\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages\/60"}],"wp:attachment":[{"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/media?parent=26268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}