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C21.0217661,8.32322397 21.0649541,8.41994317 21.1405331,8.49516921 L25.2218005,12.4069233 C25.2541915,12.439163 25.2541915,12.4714027 25.2649885,12.4928959 C25.2649885,12.5036425 25.2649885,12.5358822 25.2325975,12.5681219 Z" id="Shape"></path></g></g></g></g></svg> </span> </a> </li> <li class="breadcrumb-item"> <a href="/es/members/"> <span>Miembros</span> </a> </li> <li class="breadcrumb-item"> <a href="/es/members/chip/"> <span>Miembros de CHIP</span> </a> </li> <li class="breadcrumb-item"> <a href="/es/members/chip/forms/"> <span>Formularios CHIP</span> </a> </li> </ol> </div> <div class="interior-page"> <div class="top-content-wrapper"> <div class="content-wrapper"> <div class="document-header"> <h1 data-epi-type="title">Formularios CHIP</h1> </div> <div class="content-area" data-epi-type="content"> <div class="right-content"> <div class="score-accordion section-menu-wrapper"> <div class="score-accordion-panel"> <div class="panel-heading"> <div class="panel-title"> <button type="button" class="accordion-button" data-target="#sectionMenu" aria-expanded="false" aria-controls="accordion1"> In This Section </button> </div> </div><div id="sectionMenu" class="panel-collapse collapse"> <div class="panel-body"> <div class="bg-lightgrey"> <ul class="main"> <li class=""> <a href="/es/members/" aria-label="Miembros" class="GTMMENU" target="_self"> Miembros </a> </li> </ul> <ul class="level-1"> <li class=""> <a href="/es/members/chip/" aria-label="Miembros de CHIP" class="GTMMENU" target="_self"> Miembros de CHIP </a> <ul class="level-2"> <li class=""> <a href="/es/members/chip/benefits/" aria-label="Beneficios de CHIP" class="GTMMENU" target="_self"> Beneficios de CHIP </a> </li> <li class=""> <a href="/es/members/chip/costs/" class="GTMMENU" target="_self"> Costos de CHIP </a> </li> <li class=""> <a href="/es/members/chip/rights-and-responsibilities/" class="GTMMENU" target="_self"> Derechos y responsabilidades </a> </li> <li class=""> <a href="/es/members/chip/well-child-exams/" class="GTMMENU" target="_self"> Exámenes de niño sano </a> </li> <li class="active"> <a href="/es/members/chip/forms/" class="GTMMENU" target="_self"> Formularios CHIP </a> </li> <li class=""> <a href="/es/members/chip/member-advisory-group/" class="GTMMENU" target="_self"> Grupo de asesoría para miembros </a> </li> <li class=""> <a href="/es/members/chip/member-handbooks/" class="GTMMENU" target="_self"> Manual para miembros </a> </li> <li class=""> <a href="/es/members/chip/complaints-and-appeals/" class="GTMMENU" target="_self"> Quejas y apelaciones </a> </li> <li class=""> <a href="/es/members/chip/replace-your-id-card/" class="GTMMENU" target="_self"> Reemplace su tarjeta de identificación </a> </li> </ul> </li> <li class=""> <a href="/es/members/star/" aria-label="Miembros de STAR" class="GTMMENU" target="_self"> Miembros de STAR </a> </li> <li class=""> <a href="/es/members/star-kids/" aria-label="Miembros de STAR Kids" class="GTMMENU" target="_self"> Miembros de STAR Kids </a> </li> <li class=""> <a href="/es/members/pregnant-members/" aria-label="Miembros embarazadas" class="GTMMENU" target="_self"> Miembros embarazadas </a> </li> <li class=""> <a href="/es/members/resources/" aria-label="Recursos" class="GTMMENU" target="_self"> Recursos </a> </li> <li class=""> <a href="/es/members/pharmacy/" aria-label="Beneficio de Farmacia" class="GTMMENU" target="_self"> Beneficio de Farmacia </a> </li> <li class=""> <a href="/es/members/care-management-programs/" aria-label="Programas de administración de la atención" class="GTMMENU" target="_self"> Programas de administración de la atención </a> </li> <li class=""> <a href="/es/members/hhsc-news/" aria-label="Noticias de HHS" class="GTMMENU" target="_self"> Noticias de HHS </a> </li> <li class=""> <a href="/es/members/member-news/" aria-label="Noticias para miembros" class="GTMMENU" target="_self"> Noticias para miembros </a> </li> <li class=""> <a href="/es/covid-19-information/" aria-label="Información sobre el COVID-19" class="GTMMENU" target="_self"> Información sobre el COVID-19 </a> </li> </ul> </div> </div> </div> </div> </div> </div> <div class="top-content"> <div class="rte-content"> <div class="rich-text"><h2>Servicios con valor agregado</h2> <p>Nuestros formularios de tarjetas de regalo de servicios con valor agregado ahora se pueden encontrar en nuestro portal para miembros de MyCookChildren's. Puede accesar a estos formularios después de registrár en el portal aquí.</p> <p><a class="score-button primary" title="Portal para Miembros de MyCookChildren's" href="https://mycookchildrens.cookchp.org/MyChartHealthPlan/Authentication/Login?lang=espanol">Portal para Miembros de MyCookChildren's</a></p> <p>Una vez registrado, los formularios se pueden ubicar en Formularios VAS.</p> <h2>Formularios</h2> <p>Los siguientes formularios están disponibles para descargar en formato PDF.</p> <ul> <li><a class="GTMLINK" style="text-decoration: none;" title="Formulario de solicitud de cambio de proveedor " href="https://cookchp.org/SiteCollectionDocuments/pdfs/spanish/Provder-Change-Request-Form-Spanish.pdf" target="_blank" rel="noopener">Formulario de solicitud de cambio de proveedor (Autorizaciones)</a></li> <li><a class="GTMLINK" style="text-decoration: none;" title="Solicitud para autorizar el acceso a la cuenta" href="/siteassets/documents/secundario-subscriptor.pdf" target="_blank" rel="noopener">Solicitud para autorizar el acceso a la cuenta</a></li> </ul> <h2>Estamos aquí para ayudar</h2> <p>Llame a Servicios al Miembro si tiene alguna pregunta sobre estos formularios al <a class="GTMPHONE" style="text-decoration: none;" title="1-800-964-2247" href="tel:+1-800-964-2247">1-800-964-2247</a>. 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