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Central
Business School
Licensed by the Michigan Department
of
Energy, Labor & Economic Growth since 1994 |
Central Business School |
    
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Health
Information Coding Certificate Program
Enrollment Form
Printer-Friendly Version |
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Applicant
Name |
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Address |
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City,
State, Zip |
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Phone |
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Email
Address |
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Date of
Birth |
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Social
Security Number |
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Course # |
Course
Name |
Quantity |
Tuition & Books |
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COD101 |
Medical
Terminology
Books |
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$495
$120 |
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COD102 |
Anatomy and Physiology
Books |
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$495
$131 |
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COD103 |
Essentials of Disease
Processes
Books |
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$495
$105 |
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COD104 |
Pharmacology for Health
Professionals
Books |
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$495
$115 |
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COD105 |
Outpatient Coding and Billing – CPT/HCPCS, including CCA
preparation; medical billing procedures
Books |
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$495
$276 |
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COD106 |
Diagnostic Coding and Billing for Physician Services,
ICD-9-CM, including CCS-P preparation; medical billing
procedures
Books |
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$495
$318 |
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COD107 |
Inpatient Coding, diagnoses and procedures, including CCS preparation
Books |
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$495
$261 |
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COD108 |
12-week
Unpaid Internship in medical coding, billing, or other related
health care setting |
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$495 |
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Coding books |
ICD-9-CM
Volumes 1, 2, 3 (current year)
CPT
(current year)
HCPCS
(current year) |
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$80
$75
$75 |
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Total |
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CHECK or MONEY
ORDER ENCLOSED: ______________
CREDIT CARD INFORMATION:
____________________________ (number) ______________ (exp.)
Type of
Credit Card: MC
VISA DISCOVER
Name on
Credit Card:
PLEASE MAIL TO: CENTRAL
BUSINESS SCHOOL
PO BOX 1081
MARQUETTE MI 49855
Please allow two to three weeks
for Central Business School to process your order. For questions, e-mail
Central Business School
or call (906) 226-2743.
APPLICANT SIGNATURE:
____________________________
DATE:
____________________________
My signature
here acknowledges that I have read and understood the Tuition Agreement below.
Tuition
Agreement:
All
tuition and fees paid by the applicant shall be refunded if
the applicant is rejected by the school before enrollment.
An application fee of not more than $25.00 may be retained
by the school if the application is denied. All tuition and
fees paid by the applicant shall be refunded if requested
within three business days after signing a contract with the
school. All refunds shall be returned in 30 days.
Certificate and transcript are awarded upon successful
completion of each course. Certificate and transcript are
also awarded upon successful completion of the Health
Information Coding Certificate Program. Allowable
completion time for each course: 18 weeks from date of
enrollment.
Allowable completion time for Health Information Coding
Certificate Program: Two years from date of enrollment in
first course. No payment plan is available for the Health
Information Coding Certificate Program. Complete the
courses in order of your choice and pay for each course
separately. Program packages will be ready for
shipment two to three weeks from the date of enrollment. |
NOTICE OF CANCELLATION
(Enter date of
transaction)
Date:
You may cancel this transaction,
without penalty or obligation, within 3 business days from the above
date.
To cancel this transaction, mail or deliver a signed and dated copy
of this cancellation notice or any other written notice.
I hereby cancel this
transaction:
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