Sign Up ROI Intro

site map

Your cart is empty

Reset the menu

Online Education > Online Campus > Introduction ROI Info > Sign Up ROI Intro

Online Education for Release of Health Information in California: Introduction Module

Fees & Registration

The fees for the Release of Information Introduction Module are $20 for CHIA members and $25 for nonmembers.

Online Education Registration Form ROI Introduction

Registration Fee - Sign up as*

$20.00 (CHIA Member/Colleague)

$25.00 (Non Member)

Are you a CHIA Member or a CHIA Colleague?*

	Yes
	No

AHIMA ID Number (Please fill in if member)

First name*

Last Name*

Credentials

MAIL ADDRESS

Preferred mailing address (please check and complete appropriate boxes below)*

	Business
	Home
	Business AND Home

Employer or Business Info

Business e-mail

Business Phone (include Area Code and Extension)

Business Fax (include Area Code)

Business Name

Business Address

Business City

Business --State--

Business Zip (include zip add-on)

Job Title

Department

HOME Info

Home e-mail

Home Phone (include Area Code)

Cellular Phone (Home)

Home Address

Home City

Home --State--

Home ZIP Code (include zip add-on)

OTHER INFORMATION

PAYMENT POLICY: Registration fees are to be paid via a major credit card for immediate online access. Please complete the credit card information below.

Payment Types*

	VISA
	MasterCard
	American Express
	Discover

Card Number (no spaces or dashes)*

--Expiration Month--*

--Expiration Year--*

Cardholder Name*

Cardholder Address and City*

Cardholder ZIP Code*

NOTIFICATION regarding Module access will be sent electronically via e-mail. Please fill-in your PREFERRED e-mail address below.

Preferred e-mail*

Please click the Submit Form button only once to submit your registration request. When your registration is submitted, a new screen page appears. Please print out that screen page for your records. The "Your Responses" page is your confirmation that your registration has been submitted to CHIA. At the top of this page there will be this statement "Your form has been submitted. Click here". Doing that will return you to the CHIA Web site. Next, visit your Webmail server account.

A "Welcome" e-mail will be computer generated/sent to your preferred e-mail address from this CHIA Web site. Please follow the steps as directed on that e-mail within 24 hours to gain access to the ROI Introduction module. You will be taken to a Welcome screen where will be asked to process your password. Follow the screen instructions until reach Home Page and then you can click on Online Education, then Onine Campus to see the module for which signed up, ROI Introduction Module. You may login/logout as often as wish until complete the exam.

If you do not have a valid credit card, please contact the CHIA Executive Office (559-251-5038) regarding other options that may be available.

Built @ MSB Web Systems	© Entire contents Copyright 2007 CHIA. Last Edited May 22 2007