Healthcare Plans
That You Can Afford

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.

If you have copies, please scan and include the following documentation when you return your Medical Event Registration Form.
If you don't have a scanner, please fax the documents to HomePort at 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.