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Medical Event Registration Form

Member Affordable Healthcare Services from HomePort
Affordable Healthcare Services from HomePort

Registering Your Medical Event

This Medical Event Registration Form is used to notify CHP of your current or upcoming medical event. Please answer all the applicable questions. You can also use this form to upload the requested documents. You can also scan or fax the documents. Our fax number is 303-679-1943

  • The Initial Medical Evaluation Report, which is prepared by the medical provider in-take physician.
  • The bill for services being sent to the insurance company. Even if all the bills are not yet available.
  • The physician statement describing what services were performed.
  • Any other relevant documents the medical provider has prepared and given to you.

Note: If you don't have these copies, please contact your medical providers and request a copy. These documents are necessary to process your requests.