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.

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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):

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* 2. Please complete your contact information.

Name *

Company *

Address *

Address 2

City/Town *

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?

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* 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.

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* 5. Are you an ACDIS member?

Yes

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* 6. Are you willing to present at a local chapter meeting?

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)

Topic (please specify)

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* 7. Are you willing to host chapter meetings at your facility?

Yes

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* 8. Are you interested in serving in an officer/leadership role?

Yes

Undecided (interested in learning more)

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* 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)