CHIA Education Order Form

CHIA Education Order Form

Provide all information requested below for each employee. Each person must use their individual CHIA profile in order to access the program and CEUs. If an employee does not currently have a CHIA user profile the CHIA staff will inform the group contact person with the employee names and request that they create a profile in order to complete the order.

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

Member pricing is subject to CHIA verification, once pricing is verified an invoice will be emailed to the group contact person.

Please select education type (please ensure you are selecting the correct type of program, eLearning programs are typically held over multiple days, webinars are one 60-90 minute session)*

eLearning ProgramWebinar

If this is a group order, how would you like to be invoiced?*

One group invoiceIndividual invoice for each employee (will have separate payment links for each person)This is an individual orderOther

Webinar Title*

How many employees would like to register?*

1 - 9 employees10+ employees (eligible for a discount)

Please select an eLearning Program*

FY2026 Coding UpdatesRevenue Cycle Academy: Navigate the Revenue Cycle Maze with ConfidenceRelease of Information Academy (eBook option available)Advanced Coding WorkshopRevenue Cycle Academy: Bridging the Gaps in Revenue Integrity (4-2025)Clinical Coding Symposium - In-person Long BeacheHI SymposiumConfidentiality: Protecting & Releasing Health Information/Data in CA (bundle options available)

How many employees would like to register?*

1 employee2 - 4 employees5 - 9 employees (eligible for a discount)10+ employees (eligible for a discount)

Does your order include a publication?*

YesNo

Contact Person*

Email*

example@example.com

Pricing Information

Revenue Cycle Academy: Bridging the Gaps in Revenue Integrity (4-2025)

Revenue Cycle Academy: Navigate the Revenue Cycle Maze with Confidence

Clinical Coding Symposium: Dynamic World of Cancer Coding: Staying Ahead in a Rapidly Evolving Field

Release of Information Academy

FY2026 Coding Updates

Which part would you like?*

Full Program - 6 CEUsPart 1 - 2 CEUSPart 2 - 2 CEUsPart 3 - 2 CEUs

Which part would you like?*

eHI Symposium: AI in Healthcare: Innovation, Ethics, and Application

Which part would you like?*

Full Program - Both Parts - 4 CEUsPart 1 - California Subpoena Process: Are You on Point? - 2 CEUsPart 2 - Utilization of Patient Portals as a Way to Prevent Information Blocking - 2 CEUs

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

Which Program / Bundle would you like?*

ELP ProgramELP Program + NEW ROI eBook Full Series+ Subpoena BookELP Program + NEW ROI eBook Full SeriesELP Program + Subpoena Book

Registrant Information

	Member Type	Member Number	First Name	Last Name	Email	Include Subpoena eBook? if option is available	Price
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For eLearning Program 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 through their CHIA user profile.

Pricing subject to CHIA verification

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ELP 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: 4 CEU programs $10 off per person; 5+ CEU programs $20 off per person

Groups of 10+ people: 4 CEU programs $15 off per person; 5+ CEU programs $30 off per person

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Webinar group discount and eligibility

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

Groups of 10+ people: $5 off per person

Shipping Address

Type*

HomeBusiness

Address*

Organization / Name

Street Address Line 2

CityState / Province

Postal / Zip Code

Method of Payment

Payment must accompany order. Please note, CHIA prefers ACH or EFT payments for all group orders.

Method of Payment*

Credit Card - All forms of credit cards are accepted, an invoice payment link will be emailed to the group contact person.Enclosed Check (order form must be mailed with check payment)Check Request / Purchase order / EFT / ACH

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

Please provide contact information for the person responsible for the payment*

Upload check request or purchase order

Orders are processed 2-5 business days after receiving a completed Order Form. A registration confirmation email will be sent to the attendees 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, a secure payment link will be sent once the order has been processed. Enclosed/Attached Purchase Order, Check Requisition, or Checks (made payable to CHIA) and ACH / EFT are accepted.
Membership and pricing are subject to CHIA verification.
eLearning and Webinar Return Policy: All sales final. Non-transferable.

Any additional comments or information you would like to share?

How did you learn about this program?

Advanced Coding Workshop

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