Regional Association Membership Application - GCHIMA
The purpose of the Greater Cincinnati Health Information Management Association is to provide education, a forum for the exchange of ideas and information, and a means of providing input on the state and national level through collaborations with Ohio Health Information Management Association (OHIMA) and American Health Information Management Association (AHIMA). The membership year is from July 1st to June 30th. There are no separate regional dues to belong to GCHIMA.
GCHIMA is maintaining a database of our membership. This will allow us to make available to the members, information concerning education opportunities for specific areas without incurring the mailing cost for the entire membership.
If you are a GCHIMA officer, please return the application so you are sure to be entered into this database.
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Response Required
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1. First Name:
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2. Last Name:
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3. Credentials/Status (Check all that apply)
RHIA
RHIT
CCS
CCS-P
CCA
Other
Non-credentialed/Student
Retired
4. AHIMA ID #
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5. Street Address:
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6. City:
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7. State:
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8. Zip Code:
9. E-Mail Address:
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10. Phone:
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11. Employment Facility (check one)
Acute Care Hospital
Long-Term Care
Home Health
Physician Office
Ambulatory Care
Mental Health
Information Systems
Other (please specify)
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12. Membership status:
New Membership
Renewal
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13. Date (00/00/00)
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14. How would you like to receive GCHIMA correspondence?
E-Mail
Postal Mail
15. Comments:
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