eLearning Program Order Form

CHIA eLearning Program Order Form

For product details and pricing, visit CaliforniaHIA.org/elp

Please select an eLearning Program *

2021 Advanced Coding Workshop eHIM Symposium: The Journey Continues Towards Achieving Health Information Integrity Confidentiality: Protecting & Releasing Health Information in CA (publication option available) Countdown to Information Blocking FY2021 Coding Updates The INs and OUTs of Clinical Documentation Improvement

How many employees would like to register? *

1 employee 2 - 4 employees 5 - 9 employees (eligible for a discount) 10+ employees (eligible for a discount)

Please use this form if you are registering another person or with a check request / purchase order. If you are registering yourself with a credit card payment please login to your CHIA profile.

Does your order include a publication? *

Yes No

Your Email *

example@example.com

Pricing Information

Advanced Coding Workshop

Which part would you like? *

Full Program - All Four Parts - 12 CEUs Part 1 -Advanced Coding Concepts of ICD-10-CM - 3 CEUs Part 2 - Challenging Cases in ICD-10-PCS- 3 CEUs Part 3 - Breaking Down Operative Reports Using ICD-10-CM/PCS/CPT & Modifiers - 3 CEUs Part 4 - Advanced Inpatient Case Study and Review (Coding Practice) - 3 CEUs

eHIM Symposium: The Journey Continues Towards Achieving Health Information Integrity - 6 CEUs

Confidentiality: Protecting & Releasing Health Information in CA - 6 CEUs

Countdown to Information Blocking - 2 CEUs

FY2021 Coding Updates - full program 6 CEUs

Which part would you like? *

Full Program - 6 CEUs Part 1 - 2 CEUs Part 2 - 2 CEUs Part 3 - 2 CEUs

The INs and OUTs of Clinical Documentation Improvement - full program 6 CEUs

Which part would you like? *

Full Program - 6 CEUs Inpatient Only - 3 CEUs Outpatient Only - 3 CEUs

Registrant Information

CHIA Member?

Member Number

First Name

Last Name

Email

Include book?

Price

1

Order Total (form will calculate, do not override)

For Group Purchases Only
Use this section for orders of the same eLearning program for multiple staff members.

Complete payment information and provide CHIA with a contact person for any questions regarding this order (customer information section). Groups of 5+ are eligble for a discount.

Please complete information below for each participant. Each person must use their individual email in order to gain access to the program. If a publication is purchased with the Program, they must be shipped to one location.

Pricing subject to CHIA verification

Group Contact Person *

Registrant Information

Member?

Member Number

First Name

Last Name

Email

Include book?

Price

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Member?

Member Number

First Name

Last Name

Email

Include book?

Regular Price

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Member?

Member Number

First Name

Last Name

Email

Include book?

Regular Price

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If you have more than 15 employees please complete an additional order form.

Order Total

Group discount and eligibility

In order to be eligible for a group discount all employees must be registered for the same program.

Groups of 5 - 9 people: 1 - 4 CEU programs $5 off per person; 5+ CEU programs $10 off per person

Groups of 10+ people: 1 - 4 CEU programs $10 off per person; 5+ CEU programs $20 off per person

Total number of group registrants

Per person discount amount (see information above)

Total discount amount

Order Grand Total

Shipping Address

Type *

Home Business

Address *

Organization / Name

Street Address Line 2

City State / Province

Postal / Zip Code

Method of Payment

Payment must accompany order.

Method of Payment *

Credit Card - Contact CHIA after submitting order. order will not be processed until payment received. Enclosed Check (order form must be mailed with check payment) Check Request / Purchase order

Check No - once order is submitted you will receive an email with a PDF to print and include with your check.

Please provide contact information *

Upload check request or purchase order

Browse Files

Orders are processed 2-5 business days after receiving a completed Order Form. A confirmation email and receipt will be sent to the preferred email address.
For orders that include a Publication: The publication will be shipped 2-5 days in advance of the live program or within 5 days from date of purchase for on-demand orders. Tracking information provided upon request only. CHIA is not responsible for theft or damage of packages. Based on availability.
Payment Method: Payment must accompany order. All forms of credit cards are accepted. Enclosed/Attached Purchase Order, Check Requisition, or Checks (made payable to CHIA) are accepted. Membership and pricing are subject to CHIA verification.
eLearning Return Policy: All sales final. Non-transferable.

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