{"id":26273,"date":"2024-09-11T17:09:56","date_gmt":"2024-09-11T21:09:56","guid":{"rendered":"https:\/\/www.elderplan.org\/?page_id=26273"},"modified":"2024-11-13T15:37:57","modified_gmt":"2024-11-13T20:37:57","slug":"ancillary","status":"publish","type":"page","link":"https:\/\/www.elderplan.org\/es\/for-providers\/become-a-provider\/ancillary\/","title":{"rendered":"Solicitud para convertirse en proveedor de atenci\u00f3n auxiliar"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f28598-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"28598\">\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\/26273#wpcf7-f28598-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=\"28598\"><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-f28598-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\":28598,\"conditions\":[{\"then_field\":\"decision_letter_address\",\"and_rules\":[{\"if_field\":\"decision_letter\",\"operator\":\"equals\",\"if_value\":\"No\"}]}],\"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 atenci\u00f3n auxiliar 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<div class=\"box\"><!-- Organization Section -->\n\t\t\t<p><label>Solicitud de participaci\u00f3n como:<\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"mb-16\">Seleccione todas las opciones que correspondan.\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"requesting_participation_as\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Atenci\u00f3n diurna para adultos\"><span class=\"wpcf7-list-item-label\">Atenci\u00f3n diurna para adultos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Hogar para adultos\"><span class=\"wpcf7-list-item-label\">Hogar para adultos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Atenci\u00f3n diurna para adultos con sida\"><span class=\"wpcf7-list-item-label\">Atenci\u00f3n diurna para adultos con sida<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Centro quir\u00fargico ambulatorio\"><span class=\"wpcf7-list-item-label\">Centro quir\u00fargico ambulatorio<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Tratamiento comunitario de reafirmaci\u00f3n personal\"><span class=\"wpcf7-list-item-label\">Tratamiento comunitario de reafirmaci\u00f3n personal<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Residencia asistida\"><span class=\"wpcf7-list-item-label\">Residencia asistida<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Tecnolog\u00eda de vida asistida\"><span class=\"wpcf7-list-item-label\">Tecnolog\u00eda de vida asistida<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Audiolog\u00eda y Salud conductual\"><span class=\"wpcf7-list-item-label\">Audiolog\u00eda y Salud conductual<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Centro de rehabilitaci\u00f3n certificado para pacientes externos\"><span class=\"wpcf7-list-item-label\">Centro de rehabilitaci\u00f3n certificado para pacientes externos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Integraci\u00f3n comunitaria\"><span class=\"wpcf7-list-item-label\">Integraci\u00f3n comunitaria<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Servicios de transici\u00f3n en la comunidad\"><span class=\"wpcf7-list-item-label\">Servicios de transici\u00f3n en la comunidad<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Servicios de asistencia personal dirigida por el consumidor\"><span class=\"wpcf7-list-item-label\">Servicios de asistencia personal dirigida por el consumidor<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Tratamiento diurno y d\u00eda continuo\"><span class=\"wpcf7-list-item-label\">Tratamiento diurno y d\u00eda continuo<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Centro de Diagn\u00f3stico y Tratamiento\"><span class=\"wpcf7-list-item-label\">Centro de Diagn\u00f3stico y Tratamiento<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Servicios de di\u00e1lisis\"><span class=\"wpcf7-list-item-label\">Servicios de di\u00e1lisis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Equipo m\u00e9dico duradero\"><span class=\"wpcf7-list-item-label\">Equipo m\u00e9dico duradero<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Modificaciones ambientales\"><span class=\"wpcf7-list-item-label\">Modificaciones ambientales<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Planificaci\u00f3n familiar\"><span class=\"wpcf7-list-item-label\">Planificaci\u00f3n familiar<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Servicios de apoyo en el hogar y la comunidad\"><span class=\"wpcf7-list-item-label\">Servicios de apoyo en el hogar y la comunidad<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Entregas de comida a domicilio\"><span class=\"wpcf7-list-item-label\">Entregas de comida a domicilio<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Atenci\u00f3n m\u00e9dica en el hogar\"><span class=\"wpcf7-list-item-label\">Atenci\u00f3n m\u00e9dica en el hogar<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Hospital\"><span class=\"wpcf7-list-item-label\">Hospital<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Atenci\u00f3n de la salud mental para pacientes internados\"><span class=\"wpcf7-list-item-label\">Atenci\u00f3n de la salud mental para pacientes internados<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Laboratorio\"><span class=\"wpcf7-list-item-label\">Laboratorio<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Trabajo social m\u00e9dico\"><span class=\"wpcf7-list-item-label\">Trabajo social m\u00e9dico<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Salud m\u00f3vil\"><span class=\"wpcf7-list-item-label\">Salud m\u00f3vil<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Asistencia para la mudanza\"><span class=\"wpcf7-list-item-label\">Asistencia para la mudanza<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Dispositivos prot\u00e9sicos y ort\u00e9sicos\"><span class=\"wpcf7-list-item-label\">Dispositivos prot\u00e9sicos y ort\u00e9sicos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Atenci\u00f3n de salud mental para pacientes externos\"><span class=\"wpcf7-list-item-label\">Atenci\u00f3n de salud mental para pacientes externos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Asisente de atenci\u00f3n personal\"><span class=\"wpcf7-list-item-label\">Asisente de atenci\u00f3n personal<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Sistema personal de respuesta ante emergencias\"><span class=\"wpcf7-list-item-label\">Sistema personal de respuesta ante emergencias<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Apoyo e intervenciones conductuales positivas\"><span class=\"wpcf7-list-item-label\">Apoyo e intervenciones conductuales positivas<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Atenci\u00f3n de enfermer\u00eda privada\"><span class=\"wpcf7-list-item-label\">Atenci\u00f3n de enfermer\u00eda privada<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Servicios de terapia respiratoria\"><span class=\"wpcf7-list-item-label\">Servicios de terapia respiratoria<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Cuidados paliativos\"><span class=\"wpcf7-list-item-label\">Cuidados paliativos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Centro de atenci\u00f3n de enfermer\u00eda especializada\"><span class=\"wpcf7-list-item-label\">Centro de atenci\u00f3n de enfermer\u00eda especializada<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Estudios del sue\u00f1o\"><span class=\"wpcf7-list-item-label\">Estudios del sue\u00f1o<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Atenci\u00f3n diurna social\"><span class=\"wpcf7-list-item-label\">Atenci\u00f3n diurna social<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Programa diurno estructurado\"><span class=\"wpcf7-list-item-label\">Programa diurno estructurado<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Abuso de sustancias\"><span class=\"wpcf7-list-item-label\">Abuso de sustancias<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"requesting_participation_as[]\" value=\"Centro de atenci\u00f3n de urgencia\"><span class=\"wpcf7-list-item-label\">Centro de atenci\u00f3n de urgencia<\/span><\/label><\/span><\/span><\/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>Nombre de la organizaci\u00f3n*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"organization_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=\"organization_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>NPI de la organizaci\u00f3n*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"organizational_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=\"organizational_npi\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p class=\"small-cf7 input-help mb-24\">Este es un campo obligatorio de 10 d\u00edgitos.\n\t\t\t<\/p>\n\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=\"organizational_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=\"organizational_tin\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\t\t\t<p class=\"small-cf7 input-help mb-24\">Este es un campo obligatorio de 9 d\u00edgitos.\n\t\t\t<\/p>\n\t\t\t<p><label>Direcci\u00f3n*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"org_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=\"org_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=\"org_street_address_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"org_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=\"org_city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"org_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=\"org_state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"org_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=\"org_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=\"org_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=\"org_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=\"org_phone\"><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\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 requerido de 10 d\u00edgitos.\n\t\t\t<\/p>\n <!-- Contact Section -->\n\t\t\t<p class=\"font-22\">\u00bfA qui\u00e9n debemos contactar si tenemos alguna duda?\n\t\t\t<\/p>\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>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<\/p>\n\t\t\t<div class=\"mb-24\">\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><label>Correo electr\u00f3nico*<\/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<div class=\"mb-32\">\n\t\t\t<\/div>\n\t\t\t<p><label>\u00bfDebe enviarse la carta de decisi\u00f3n a la direcci\u00f3n indicada anteriormente?*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"decision_letter\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"decision_letter\" 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=\"decision_letter\" value=\"No\"><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<div class=\"mb-24\">\n\t\t\t<\/div>\n\n <!-- Conditional Section for Decision Letter Address -->\n\t\t\t<div data-id=\"decision_letter_address\" data-orig_data_id=\"decision_letter_address\" class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t<div class=\"group-green-box-lt mb-24\">\n\t\t\t\t\t<p class=\"font-22\">Indique la direcci\u00f3n a la que debe enviarse la carta de decisi\u00f3n\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<p><label>Direcci\u00f3n*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"decision_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=\"decision_street_address\"><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<p><label>Direcci\u00f3n 2<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"decision_street_address_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"decision_street_address_2\"><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<p><label>Ciudad*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"decision_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=\"decision_city\"><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<p><label>Estado*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"decision_state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"decision_state\"><option value=\"New York\">New York<\/option><\/select><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<div class=\"mb-24\">\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<p><label>C\u00f3digo Postal*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"decision_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=\"decision_zip\"><\/span>\n\t\t\t\t\t<\/p>\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=\"9FE1D9B7-7179-4B71-8848-959C6D2CDB9A\"><\/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 Ancillary Care 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 [...]","protected":false},"author":21,"featured_media":0,"parent":60,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-26273","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":"2026-04-19 05:14:16","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\/26273","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=26273"}],"version-history":[{"count":0,"href":"https:\/\/www.elderplan.org\/es\/wp-json\/wp\/v2\/pages\/26273\/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=26273"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}