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Online Education > Online Campus > ROI Government Agencies > Sign Up ROI Government Agencies

Online Education for Release of Health Information in California: GOVERNMENT AGENCIES Module

Fees & Registration

The fees for the Release of Information Government Agencies module are $35 for CHIA members and $40 for nonmembers.

A "User Welcome" e-mail from the Webmaster 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 General Releases module. 90-days have been allotted to complete this module.

Online Education Registration Form

Registration Fee - Sign up as*

$35.00 (CHIA Member/Colleague)

$40.00 (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

Preferred Mailing/Contact Address (Business Name, if applicable, street, city, state, zip)*

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. Visit your mail box (e-mail).

A "User 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 Government Agencies 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. The course name ''ROI Government Agencies Module'' will now be listed on the Menu Bar under "Online Education." Click on this module name to begin the actual module course review. You may login/logout as often as wish over the allotted 90-day period of time until complete the exam. Once your password has been established, you can go directly to http://www.CaliforniaHIA.org to log on; click on the "Log in" tab on the blue tool bar under the graphic at the top of the CHIA Home page, fill in your user name and password, then click on the module name on the menu bar.

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