{"id":1332,"date":"2025-04-21T22:54:41","date_gmt":"2025-04-21T22:54:41","guid":{"rendered":"https:\/\/disabilityhelpgroup.org\/formulario-de-ingreso\/"},"modified":"2025-05-21T23:12:00","modified_gmt":"2025-05-21T23:12:00","slug":"formulario-de-ingreso","status":"publish","type":"page","link":"https:\/\/disabilityhelpgroup.org\/es\/formulario-de-ingreso\/","title":{"rendered":"Formulario de ingreso"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1332\" class=\"elementor elementor-1332 elementor-1038\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7359dcdc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7359dcdc\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-49495460\" data-id=\"49495460\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6aac0e11 elementor-widget elementor-widget-heading\" data-id=\"6aac0e11\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Formulario de ingreso<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b837728 elementor-widget elementor-widget-text-editor\" data-id=\"b837728\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"ea-card ea-expand sp-ea-single\"><div id=\"collapse27090\" class=\"sp-collapse spcollapse collapsed show\" role=\"region\" data-parent=\"#sp-ea-2709\" aria-labelledby=\"ea-header-27090\"><div class=\"ea-body\"><p>El Formulario de Admisi\u00f3n para el Grupo de Ayuda para Discapacitados de Arizona es un documento preliminar dise\u00f1ado para recopilar informaci\u00f3n esencial sobre el historial m\u00e9dico, la discapacidad y las circunstancias personales de un solicitante. Sirve como el primer paso para iniciar el proceso de solicitud del Seguro de Incapacidad del Seguro Social (SSDI) o del Ingreso Suplementario por Incapacidad (SSI), lo que permite a nuestro equipo comprender su situaci\u00f3n particular y adaptar nuestra asistencia en consecuencia.<\/p><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-9dbb5de e-con-full e-flex e-con e-parent\" data-id=\"9dbb5de\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-86c3e0c elementor-widget elementor-widget-elementskit-contact-form7\" data-id=\"86c3e0c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"elementskit-contact-form7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"ekit-wid-con\" ><div class=\"ekit-form\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1327-p1332-o1\" lang=\"es-ES\" dir=\"ltr\" data-wpcf7-id=\"1327\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/formulario-de-ingreso\/#wpcf7-f1327-p1332-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-auto-return-first-step cf7mls-no-moving-animation\" aria-label=\"Formulario de contacto\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1327\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_ES\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1327-p1332-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"1332\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"fieldset-cf7mls-wrapper\" data-transition-effects><fieldset class=\"fieldset-cf7mls cf7mls_current_fs\"><div class=\"form-group\">\n\t<div class=\"col-lg-12\">\n\t\t<h3>Tu informaci\u00f3n\n\t\t<\/h3>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Nombre: *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first_last_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Nombre completo\" value=\"\" type=\"text\" name=\"first_last_name\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">DOB: *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date_of_birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"date_of_birth\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Edad: *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"age\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput2\">Correo electr\u00f3nico: *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput2\">Tel\u00e9fono *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput2\">Fuente de referencia: *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"referral_source\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"referral_source\"><option value=\"\">Por favor selecciona...<\/option><option value=\"B\u00fasqueda en internet\">B\u00fasqueda en internet<\/option><option value=\"Amigo(a)\">Amigo(a)<\/option><option value=\"Visita sin cita\">Visita sin cita<\/option><option value=\"Otro\">Otro<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput2\">\u00bfAlguna enfermedad infecciosa?<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"infectious_disease\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"infectious_disease\" value=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"infectious_disease\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"col-lg-12\">\n\t<h3>A continuaci\u00f3n, enumera todos los diagn\u00f3sticos mentales y f\u00edsicos que has recibido de tu m\u00e9dico.\n\t<\/h3>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 1\" value=\"\" type=\"text\" name=\"diagnosis_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 6\" value=\"\" type=\"text\" name=\"diagnosis_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 2\" value=\"\" type=\"text\" name=\"diagnosis_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 7\" value=\"\" type=\"text\" name=\"diagnosis_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 3\" value=\"\" type=\"text\" name=\"diagnosis_5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 8\" value=\"\" type=\"text\" name=\"diagnosis_6\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_7\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 4\" value=\"\" type=\"text\" name=\"diagnosis_7\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_8\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 9\" value=\"\" type=\"text\" name=\"diagnosis_8\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_9\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 5\" value=\"\" type=\"text\" name=\"diagnosis_9\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-6\">\n\t\t<p><label for=\"formGroupExampleInput\"><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis_10\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Diagn\u00f3stico mental o f\u00edsico 10\" value=\"\" type=\"text\" name=\"diagnosis_10\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-1\" style=\"background-color: #fb8500; color: #ffffff\">Siguiente<img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" class=\"lazyload\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><noscript><img decoding=\"async\" src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/noscript><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<div class=\"col-lg-12\">\n\t<h3>A continuaci\u00f3n, por favor enumera todos los medicamentos que est\u00e1s tomando actualmente y el nombre del m\u00e9dico que te los recet\u00f3.\n\t<\/h3>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Medicamento<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medication_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Medicamento 1\" value=\"\" type=\"text\" name=\"medication_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Usado para<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"used_for_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"used_for_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Doctor<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"doctor_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"doctor_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Medicamento<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medication_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Medicamento 2\" value=\"\" type=\"text\" name=\"medication_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Usado para<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"used_for_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"used_for_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Doctor<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"doctor_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"doctor_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Medicamento<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medication_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Medicamento 3\" value=\"\" type=\"text\" name=\"medication_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Usado para<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"used_for_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"used_for_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Doctor<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"doctor_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"doctor_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Medicamento<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medication_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Medicamento 4\" value=\"\" type=\"text\" name=\"medication_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Usado para<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"used_for_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"used_for_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Doctor<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"doctor_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"doctor_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Medicamento<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medication_5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Medicamento 5\" value=\"\" type=\"text\" name=\"medication_5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Usado para<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"used_for_5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"used_for_5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-4\">\n\t\t<p><label for=\"formGroupExampleInput\">Doctor<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"doctor_5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"doctor_5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-2\" style=\"background-color: #fb8500; color: #ffffff\">Anterior<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-2\" style=\"background-color: #fb8500; color: #ffffff\">Siguiente<img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" class=\"lazyload\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><noscript><img decoding=\"async\" src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/noscript><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<div class=\"col-lg-12\">\n\t<h3>A continuaci\u00f3n, por favor enumera tu historial laboral de los \u00faltimos 15 a\u00f1os.\n\t<\/h3>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput\">Nombre de la empresa<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"name_of_business_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name_of_business_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de inicio<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"start_date_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"start_date_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de termino<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"end_date_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"end_date_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Ciudad\/Estado<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city_state_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city_state_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Salario<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"salary_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"salary_1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput\">Nombre de la empresa<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"name_of_business_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name_of_business_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de inicio<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"start_date_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"start_date_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de termino<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"end_date_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"end_date_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Ciudad\/Estado<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city_state_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city_state_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Salario<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"salary_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"salary_2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput\">Nombre de la empresa<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"name_of_business_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name_of_business_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de inicio<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"start_date_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"start_date_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de termino<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"end_date_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"end_date_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Ciudad\/Estado<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city_state_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city_state_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Salario<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"salary_3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"salary_3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-group\">\n\t<div class=\"col-lg-3\">\n\t\t<p><label for=\"formGroupExampleInput\">Nombre de la empresa<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"name_of_business_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name_of_business_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de inico<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"start_date_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"start_date_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Fecha de termino<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"end_date_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. 11\/16\/1980\" value=\"\" type=\"text\" name=\"end_date_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Ciudad\/Estado<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city_state_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city_state_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-lg-2\">\n\t\t<p><label for=\"formGroupExampleInput\">Salario<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"salary_4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"salary_4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><div class=\"cf7mls-btns \"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-3\" style=\"background-color: #fb8500; color: #ffffff\">Anterior<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-3\" style=\"background-color: #fb8500; color: #ffffff\">Siguiente<img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" class=\"lazyload\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><noscript><img decoding=\"async\" src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/noscript><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<div class=\"col-lg-12\">\n\t<h3>A continuaci\u00f3n, por favor enumera las diferentes cl\u00ednicas\/hospitales a los que has asistido: incluye el nombre, la fecha en que fuiste por primera vez, el motivo de la visita. Tambi\u00e9n indica si a\u00fan acudes a ese lugar y, si no, cu\u00e1ndo fue la \u00faltima vez que estuviste all\u00ed.\n\t<\/h3>\n\t<p><b>**Por favor, agrega la direcci\u00f3n y el n\u00famero de tel\u00e9fono de cada cl\u00ednica\/hopsital que hayas listado<\/b>\n\t<\/p>\n<\/div>\n<div class=\"panel panel-default\">\n\t<div class=\"panel-body\">\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Cl\u00ednica\/Hospital\/Cualquier centro de atenci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_hospital_any_treating_facility1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_hospital_any_treating_facility1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">N\u00famero de tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Direcci\u00f3n del establecimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address_of_facility1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_of_facility1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-8\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Motivo de la visita:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason_for_going1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason_for_going1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Primera visita Mes\/A\u00f1o:<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"first_visit_month_year1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. Jan\/1980\" value=\"\" type=\"text\" name=\"first_visit_month_year1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">\u00daltima visita o Actualmente asistiendo:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_visit_or_present1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_visit_or_present1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"panel panel-default\">\n\t<div class=\"panel-body\">\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Cl\u00ednica\/Hospital\/Cualquier centro de atenci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_hospital_any_treating_facility2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_hospital_any_treating_facility2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">N\u00famero de tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Direcci\u00f3n del establecimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address_of_facility2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_of_facility2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-8\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Motivo de la visita:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason_for_going2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason_for_going2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Primera visita Mes\/A\u00f1o:<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"first_visit_month_year2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. Jan\/1980\" value=\"\" type=\"text\" name=\"first_visit_month_year2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">\u00daltima visita o Actualmente asistiendo:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_visit_or_present2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_visit_or_present2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"panel panel-default\">\n\t<div class=\"panel-body\">\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Cl\u00ednica\/Hospital\/Cualquier centro de atenci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_hospital_any_treating_facility3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_hospital_any_treating_facility3\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">N\u00famero de tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number3\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Direcci\u00f3n del establecimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address_of_facility3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_of_facility3\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-8\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Motivo de la visita:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason_for_going3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason_for_going3\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Primera visita Mes\/A\u00f1o:<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"first_visit_month_year3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. Jan\/1980\" value=\"\" type=\"text\" name=\"first_visit_month_year3\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">\u00daltima visita o Actualmente asistiendo:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_visit_or_present3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_visit_or_present3\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"panel panel-default\">\n\t<div class=\"panel-body\">\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Cl\u00ednica\/Hospital\/Cualquier centro de atenci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_hospital_any_treating_facility4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_hospital_any_treating_facility4\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">N\u00famero de tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number4\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Direcci\u00f3n del establecimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address_of_facility4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_of_facility4\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-8\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Motivo de la visita:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason_for_going4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason_for_going4\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Primera visita Mes\/A\u00f1o:<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"first_visit_month_year4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. Jan\/1980\" value=\"\" type=\"text\" name=\"first_visit_month_year4\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">\u00daltima visita o Actualmente asistiendo:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_visit_or_present4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_visit_or_present4\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"panel panel-default\">\n\t<div class=\"panel-body\">\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Cl\u00ednica\/Hospital\/Cualquier centro de atenci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_hospital_any_treating_facility5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_hospital_any_treating_facility5\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">N\u00famero de tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number5\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Direcci\u00f3n del establecimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address_of_facility5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_of_facility5\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-8\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Motivo de la visita:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason_for_going5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason_for_going5\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Primera visita Mes\/A\u00f1o:<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"first_visit_month_year5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. Jan\/1980\" value=\"\" type=\"text\" name=\"first_visit_month_year5\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">\u00daltima visita o Actualmente asistiendo:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_visit_or_present5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_visit_or_present5\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"panel panel-default\">\n\t<div class=\"panel-body\">\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Cl\u00ednica\/Hospital\/Cualquier centro de atenci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_hospital_any_treating_facility6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_hospital_any_treating_facility6\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">N\u00famero de tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number6\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Direcci\u00f3n del establecimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address_of_facility6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_of_facility6\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-8\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Motivo de la visita:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason_for_going6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason_for_going6\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Primera visita Mes\/A\u00f1o:<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"first_visit_month_year6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. Jan\/1980\" value=\"\" type=\"text\" name=\"first_visit_month_year6\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">\u00daltima visita o Actualmente asistiendo:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_visit_or_present6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_visit_or_present6\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"panel panel-default\">\n\t<div class=\"panel-body\">\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Cl\u00ednica\/Hospital\/Cualquier centro de atenci\u00f3n:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_hospital_any_treating_facility7\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_hospital_any_treating_facility7\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">N\u00famero de tel\u00e9fono:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number7\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number7\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-4\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Direcci\u00f3n del establecimiento:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address_of_facility7\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address_of_facility7\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"form-group\">\n\t\t\t<div class=\"col-lg-8\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Motivo de la visita:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reason_for_going7\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"reason_for_going7\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">Primera visita Mes\/A\u00f1o:<br \/>\n<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"first_visit_month_year7\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"e.g. Jan\/1980\" value=\"\" type=\"text\" name=\"first_visit_month_year7\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-lg-2\">\n\t\t\t\t<p><label for=\"formGroupExampleInput\">\u00daltima visita o Actualmente asistiendo:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_visit_or_present7\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_visit_or_present7\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner btn btn-success\" type=\"submit\" value=\"Enviar\" \/><div class=\"cf7mls-btns cf7mls-btns-last-step\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-4\" style=\"background-color: #fb8500; color: #ffffff\">Anterior<\/button><button type=\"button\" style=\"display: none;\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-4\" style=\"background-color: #fb8500; color: #ffffff\"><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" class=\"lazyload\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><noscript><img decoding=\"async\" src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" alt=\"Step Loading\" data-lazy-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/cf7-multi-step\/assets\/frontend\/img\/loader.svg\" style=\"display: none;\"><\/noscript><\/button>\n<\/p><\/fieldset><\/div>\n<\/form>\n<\/div>\n<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-688b77b e-flex e-con-boxed e-con e-parent\" data-id=\"688b77b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5e082f6 elementor-widget elementor-widget-shortcode\" data-id=\"5e082f6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style>#sp-ea-2709 .spcollapsing { height: 0; overflow: hidden; transition-property: height;transition-duration: 300ms;}#sp-ea-2709{ position: relative; }#sp-ea-2709 .ea-card{ opacity: 0;}#eap-preloader-2709{ position: absolute; left: 0; top: 0; height: 100%;width: 100%; text-align: center;display: flex; align-items: center;justify-content: center;}#sp-ea-2709.sp-easy-accordion>.sp-ea-single {margin-bottom: 10px; border: 1px solid #e2e2e2; }#sp-ea-2709.sp-easy-accordion>.sp-ea-single>.ea-header a {color: #023047;}#sp-ea-2709.sp-easy-accordion>.sp-ea-single>.sp-collapse>.ea-body {background: #fff; color: #444;}#sp-ea-2709.sp-easy-accordion>.sp-ea-single {background: #eee;}#sp-ea-2709.sp-easy-accordion>.sp-ea-single>.ea-header a .ea-expand-icon { float: left; color: #fb8500;font-size: 16px;}<\/style><div id=\"sp_easy_accordion-1745955145\"><div id=\"sp-ea-2709\" class=\"sp-ea-one sp-easy-accordion\" data-ea-active=\"ea-click\" data-ea-mode=\"vertical\" data-preloader=\"1\" data-scroll-active-item=\"\" data-offset-to-scroll=\"0\"><div id=\"eap-preloader-2709\" class=\"accordion-preloader\"><img decoding=\"async\" src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/easy-accordion-free\/public\/assets\/ea_loader.svg\" class=\"lazyload\" alt=\"Loader image\"><noscript><img decoding=\"async\" src=\"https:\/\/disabilityhelpgroup.org\/wp-content\/plugins\/easy-accordion-free\/public\/assets\/ea_loader.svg\" alt=\"Loader image\"><\/noscript><\/div><div class=\"ea-card ea-expand sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27090\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27090\" aria-controls=\"collapse27090\" href=\"#\" aria-expanded=\"true\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-minus\"><\/i> \u00bfCu\u00e1l es el prop\u00f3sito del Formulario de Admisi\u00f3n para el Grupo de Ayuda para Discapacitados de Arizona?<\/a><\/h3><div class=\"sp-collapse spcollapse collapsed show\" id=\"collapse27090\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27090\"> <div class=\"ea-body\"><p>El Formulario de Admisi\u00f3n para el Grupo de Ayuda para Discapacitados de Arizona es un documento preliminar dise\u00f1ado para recopilar informaci\u00f3n esencial sobre el historial m\u00e9dico, la discapacidad y las circunstancias personales de un solicitante. Sirve como el primer paso para iniciar el proceso de solicitud del Seguro de Incapacidad del Seguro Social (SSDI) o del Ingreso Suplementario por Incapacidad (SSI), lo que permite a nuestro equipo comprender su situaci\u00f3n particular y adaptar nuestra asistencia en consecuencia.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27091\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27091\" aria-controls=\"collapse27091\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfC\u00f3mo beneficia el env\u00edo del Formulario de Admisi\u00f3n a mi proceso de solicitud?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27091\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27091\"> <div class=\"ea-body\"><p>Al enviar el Formulario de Admisi\u00f3n, usted permite a nuestro equipo evaluar su elegibilidad para recibir asistencia y comenzar a representarlo en sus reclamos de Seguro Social. Este paso inicial es crucial para que podamos recopilar la informaci\u00f3n necesaria y abogar eficazmente en su nombre durante todo el proceso de solicitud de SSDI o SSI.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27092\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27092\" aria-controls=\"collapse27092\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfQu\u00e9 informaci\u00f3n debo proporcionar en el Formulario de Admisi<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27092\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27092\"> <div class=\"ea-body\"><p>Deber\u00e1 proporcionar informaci\u00f3n personal, incluyendo su nombre y datos de contacto, as\u00ed como documentaci\u00f3n de sus condiciones m\u00e9dicas. Es importante responder a todas las preguntas con precisi\u00f3n para darle a nuestro equipo de defensa una visi\u00f3n completa de su situaci\u00f3n. Adem\u00e1s, reunir los registros m\u00e9dicos relevantes que respalden su reclamo puede afectar significativamente el resultado de su solicitud.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27093\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27093\" aria-controls=\"collapse27093\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfQu\u00e9 debo hacer si tengo preguntas al completar el Formulario de Admisi\u00f3n?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27093\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27093\"> <div class=\"ea-body\"><p>Si encuentras alguna pregunta o dificultad al completar el Formulario de Admisi\u00f3n, nuestro equipo est\u00e1 aqu\u00ed para ayudarte. Puedes comunicarte con nosotros a trav\u00e9s de nuestra p\u00e1gina de Contacto para obtener asistencia. Nuestros experimentados defensores est\u00e1n listos para resolver cualquier inquietud que puedas tener.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27094\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27094\" aria-controls=\"collapse27094\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfQu\u00e9 sucede despu\u00e9s de enviar el Formulario de Admisi\u00f3n?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27094\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27094\"> <div class=\"ea-body\"><p>Despu\u00e9s de enviar su Formulario de Admisi\u00f3n, nuestro equipo del Grupo de Ayuda para Discapacitados revisar\u00e1 la informaci\u00f3n y priorizar\u00e1 su caso. Nos comunicaremos con usted para discutir los siguientes pasos en su solicitud de beneficios por discapacidad, lo que puede incluir la recopilaci\u00f3n de pruebas adicionales o la programaci\u00f3n de una consulta. Esta evaluaci\u00f3n exhaustiva garantiza que podamos abogar eficazmente por usted durante todo el proceso de solicitud de SSDI o SSI.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27095\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27095\" aria-controls=\"collapse27095\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfC\u00f3mo se utiliza la informaci\u00f3n que proporciono en el Formulario de Admisi\u00f3n?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27095\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27095\"> <div class=\"ea-body\"><p>La informaci\u00f3n que usted proporciona en el Formulario de Admisi\u00f3n se utiliza exclusivamente para evaluar su elegibilidad para el SSDI o SSI y para ayudar a construir su caso. Nuestro compromiso con la confidencialidad del cliente garantiza que sus datos personales y m\u00e9dicos se almacenen de forma segura y solo se compartan con el personal autorizado involucrado en su caso, protegiendo su privacidad mientras se buscan sus beneficios por discapacidad.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27096\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27096\" aria-controls=\"collapse27096\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfPuedo actualizar mi informaci\u00f3n despu\u00e9s de enviar el Formulario de Admisi\u00f3n?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27096\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27096\"> <div class=\"ea-body\"><p>S\u00ed, puede actualizar su informaci\u00f3n en cualquier momento despu\u00e9s de enviar su Formulario de Admisi\u00f3n. Si hay alg\u00fan cambio en su condici\u00f3n m\u00e9dica, historial laboral o detalles personales, inf\u00f3rmenos lo antes posible. Mantener su informaci\u00f3n precisa y actualizada es crucial para que podamos abogar eficazmente en su nombre durante todo el proceso de solicitud de SSDI o SSI.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27097\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27097\" aria-controls=\"collapse27097\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfHay alguna tarifa por enviar el Formulario de Admisi\u00f3n?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27097\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27097\"> <div class=\"ea-body\"><p>No hay ninguna tarifa asociada con la presentaci\u00f3n del Formulario de Admisi\u00f3n al Grupo de Ayuda para Discapacitados de Arizona. Nuestro objetivo es brindar apoyo accesible a las personas que buscan beneficios por discapacidad del Seguro Social. Discutiremos cualquier costo potencial y nuestra estructura de tarifas en detalle una vez que comencemos a trabajar en su caso, garantizando la transparencia durante todo el proceso.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27098\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27098\" aria-controls=\"collapse27098\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfCu\u00e1nto tiempo se tarda en procesar el Formulario de Admisi\u00f3n?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27098\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27098\"> <div class=\"ea-body\"><p>El tiempo de procesamiento del Formulario de Admisi\u00f3n var\u00eda seg\u00fan el volumen de solicitudes que recibamos y la complejidad de cada caso individual. Generalmente, puede esperar tener noticias de nuestro equipo a los pocos d\u00edas de haberlo enviado. Priorizamos su solicitud para asegurar que comencemos a trabajar en su caso de la manera m\u00e1s eficiente posible.<\/p><\/div><\/div><\/div><div class=\"ea-card sp-ea-single\"><h3 class=\"ea-header\"><a class=\"collapsed\" id=\"ea-header-27099\" role=\"button\" data-sptoggle=\"spcollapse\" data-sptarget=\"#collapse27099\" aria-controls=\"collapse27099\" href=\"#\" aria-expanded=\"false\" tabindex=\"0\"><i aria-hidden=\"true\" role=\"presentation\" class=\"ea-expand-icon eap-icon-ea-expand-plus\"><\/i> \u00bfQu\u00e9 debo hacer si no he recibido una respuesta despu\u00e9s de enviar el Formulario de Admisi\u00f3n?<\/a><\/h3><div class=\"sp-collapse spcollapse \" id=\"collapse27099\" data-parent=\"#sp-ea-2709\" role=\"region\" aria-labelledby=\"ea-header-27099\"> <div class=\"ea-body\"><p>Si no ha recibido una respuesta dentro del plazo esperado despu\u00e9s de enviar su Formulario de Admisi\u00f3n, no dude en ponerse en contacto con nosotros. Puede comunicarse con nosotros directamente por tel\u00e9fono o correo electr\u00f3nico, y estaremos encantados de hacer un seguimiento del estado de su solicitud. Nuestro equipo se compromete a brindar asistencia oportuna y a garantizar que tenga el apoyo necesario durante su proceso de reclamo por discapacidad.<\/p><\/div><\/div><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Formulario de ingreso El Formulario de Admisi\u00f3n para el Grupo de Ayuda para Discapacitados de Arizona es un documento preliminar dise\u00f1ado para recopilar informaci\u00f3n esencial sobre el historial m\u00e9dico, la discapacidad y las circunstancias personales de un solicitante. Sirve como el primer paso para iniciar el proceso de solicitud del Seguro de Incapacidad del Seguro &#8230; <a title=\"Formulario de ingreso\" class=\"read-more\" href=\"https:\/\/disabilityhelpgroup.org\/es\/formulario-de-ingreso\/\" aria-label=\"Leer m\u00e1s sobre Formulario de ingreso\">Leer m\u00e1s<\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-1332","page","type-page","status-publish"],"acf":[],"_links":{"self":[{"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/pages\/1332","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/comments?post=1332"}],"version-history":[{"count":25,"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/pages\/1332\/revisions"}],"predecessor-version":[{"id":5019,"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/pages\/1332\/revisions\/5019"}],"wp:attachment":[{"href":"https:\/\/disabilityhelpgroup.org\/es\/wp-json\/wp\/v2\/media?parent=1332"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}