AEHIA membership is open to CAOs and senior applications leaders at healthcare provider and payer organizations. The mission of AEHIA is to advance the role of the CAO through education, collaboration, and advocacy in support of the applications that improve healthcare delivery and efficiency. If you are with a vendor organization, please find the AEHIA Foundation application here. Personal InformationName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Designation Graduate Degree(s)Job Title*Birth Date MM DD YYYY Gender*MaleFemaleAssociation Membership(s) ACHE AHA AHIA AHIMA HFMA HIMSS IANS SANS Other Please SpecifyOrganizational InformationOrganization Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Primary Phone Number*Alternate Phone NumberMobile Phone NumberPrimary Email* Enter Email Confirm Email Alternate Email Enter Email Confirm Email Organization's WebsiteTo whom do you report? (CEO, COO, etc.)What is the name of your organization's CIO?* First Last Demographic InformationWhat are your areas of expertise?* CPOE Financial/Administrative Systems ICD-10 Coding Mobile Devices and Wireless Technology Health Information Exchange Other Clinical Systems Which best describes your facility/organization?*Ambulatory Facility/ClinicBehavioral Health CareGroup Practice/ClinicHealth Insurer/Insurance OrganizationHospiceHospital/Acute Care FacilityIntegrated Delivery System/NetworkLaboratoryManaged CareMSONursing HomeSpecialty Hospital (Children, Cancer, Rehab, etc.)OtherPlease SpecifyNumber of staffed inpatient beds1-2525-99100-249250-399400-9991,000+Not ApplicableAdditional InformationHow did you hear about AEHIA?Would you be willing to speak to your peers about AEHIA?YesNoNot sureWould you be interested in participating in any of the following AEHIS committees?(Select all that apply) Professional Development & Education Develop appropriate career paths for healthcare applications leaders and associated tracks; solicit/schedule presenters for webinars; solicit/review best practices from membership for KnowledgeHub entry. AEHIA Fall Summit PlanningPlan the AEHIA Fall Summit in San Antonio on Oct 31; set the agenda and determine appropriate subjects/speakers for presentations. Memebership & MarketingDevelop and/or refine marketing talking points/messaging for recruiting and retaining membership; determine what constitutes an eligible AEHIA member; develop strategies to increase, engage, and retain membership.
