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Online ACDIS local chapter roster
Please tell us which ACDIS local chapter you belong to (or wish to join) and complete your contact information below.
*Please note: ACDIS does not sell the local chapter roster to any third parties.
OK
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1.
Please select your ACDIS local chapter or networking group (note: the name of your chapter or topic-based networking group may be the same as your state or may be specific to your region, please select the chapter you wish to join):
(Required.)
Arizona
California
Canada
CDI Educators
Colorado
East Mediterranean
Florida
Georgia
Illinois
Indiana
Kentucky
Maine
Maryland
Michigan
Minnesota
Missouri: Kansas City
Missouri: St. Louis
New England: Massachusetts, Rhode Island, New Hampshire, and Vermont
Nevada
New York: Greater New York
North Carolina
Northwest: Idaho, Oregon, Washington
New Jersey: Northern
Ohio
Pediatric Networking Group
Pennsylvania: Central Pennsylvania
Pennsylvania: Philadelphia/New Jersey: Southern
South Carolina
Tennessee
Texas
Virginia
Wisconsin
I don't have a chapter or group affiliation/there's no group near me
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2.
Please complete your contact information.
(Required.)
Name
*
Company
*
Address
*
Address 2
City/Town
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State/Province
*
ZIP/Postal Code
*
Country
*
Email Address
*
Phone Number
*
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3.
What is a secondary email address that may be used to contact you?
(Required.)
4.
Which best represents your reason for filling out the local chapter roster?
I am registering as a new local chapter member.
I am a current local chapter member updating my information.
*
5.
Are you an ACDIS member?
(Required.)
Yes
No
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6.
Are you willing to present at a local chapter meeting?
(Required.)
Yes, for my local chapter (please specify a topic below)
Yes, for both my local chapter & other chapters via webinar (please specify a topic below)
No
Topic (please specify)
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7.
Are you willing to host chapter meetings at your facility?
(Required.)
Yes
No
*
8.
Are you interested in serving in an officer/leadership role?
(Required.)
Yes
No
Undecided (interested in learning more)
9.
Please indicate your title/role:
CDI specialist
CDI second level reviewer
CDI lead
CDI supervisor
CDI manager
CDI director
CDI auditor
CDI educator
CDI physician educator
CDI informaticist/analyst
CDI-coding liaison
CDI quality specialist
CDI denials specialist
HIM coding supervisor
HIM/coding manager
HIM/coding director
HIM/coding professional
Physician advisor/champion
Hospital executive
Consultant
Vendor
Other (please specify)
Current Progress,
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