{"id":4824,"date":"2021-04-07T14:52:43","date_gmt":"2021-04-07T18:52:43","guid":{"rendered":"https:\/\/www.amidacareny.org\/es\/?page_id=4824"},"modified":"2021-05-18T10:42:21","modified_gmt":"2021-05-18T14:42:21","slug":"mi-amida-care-forma","status":"publish","type":"page","link":"https:\/\/www.amidacareny.org\/es\/para-miembros\/my-amida-care\/mi-amida-care-forma\/","title":{"rendered":"Formulario de registro de My Amida Care"},"content":{"rendered":"<form action=\"https:\/\/webto.salesforce.com\/servlet\/servlet.WebToCase?encoding=UTF-8\" method=\"POST\" id=\"amidaappform\">\n<input type=hidden name=\"orgid\" value=\"00D41000001OofP\"><input type=hidden name=\"retURL\" value=\"https:\/\/www.amidacareny.org\/es\/para-miembros\/my-amida-care\/agradecer\/\"><\/p>\n<p>Nombre:<input  id=\"00N2M00000fAEWr\" maxlength=\"100\" name=\"00N2M00000fAEWr\" size=\"20\" type=\"text\" \/><\/p>\n<p>Apellido:<input  id=\"00N2M00000fAEWs\" maxlength=\"100\" name=\"00N2M00000fAEWs\" size=\"20\" type=\"text\" \/><\/p>\n<p>CIN Miembro:<input  id=\"00N2M00000fAEWq\" maxlength=\"10\" name=\"00N2M00000fAEWq\" size=\"20\" type=\"text\" \/><br \/>\n* Puede encontrar esto en su tarjeta de identificaci\u00f3n de Amida Care o tarjeta de Medicaid<\/p>\n<p>Correo Electr\u00f3nico del Miembro:<input  id=\"00N2M00000fAEX0\" maxlength=\"80\" name=\"00N2M00000fAEX0\" size=\"20\" type=\"text\" \/><\/p>\n<p>N\u00famero de M\u00f3vil del Miembro:<input  id=\"00N2M00000fAEWv\" maxlength=\"40\" name=\"00N2M00000fAEWv\" onkeydown=\"formatPhoneOnEnter(this, event);\" size=\"20\" type=\"text\" \/><\/p>\n<p><input type=\"hidden\" id=\"origin\"  name=\"origin\"  value=\"MYAC Web-to-Case\" \/><input type=\"hidden\" id=\"subject\"  name=\"subject\"  value=\"New MYAC Credentialing Request\" \/><input type=\"hidden\" id=\"type\"  name=\"type\"  value=\"My Amida App\" \/><input type=\"hidden\" id=\"00N4100000LZkCO\" name=\"00N4100000LZkCO\"  value=\"Enrollment\" \/><input type=\"hidden\" id=\"external\" name=\"external\" value=\"1\" \/><br \/><input type=\"submit\" name=\"submit\"><br \/>\n<\/form>\n","protected":false},"excerpt":{"rendered":"<p>Nombre: Apellido: CIN Miembro: * Puede encontrar esto en su tarjeta de identificaci\u00f3n de Amida Care o tarjeta de Medicaid Correo Electr\u00f3nico del Miembro: N\u00famero&#8230;<\/p>\n","protected":false},"author":18,"featured_media":0,"parent":4752,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-4824","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - 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