EARN CEU’S FOR ARTICLES IN THE CAHQ JOURNAL CALIFORNIA ASSOCIATION FOR HEALTHCARE QUALITY CONTINUING EDUCATION THROUGH SELF-STUDY

To obtain CE credit for CE-designated articles (1 hour per article; CA BRN provider #03370) published in CAHQ’s Journal for Healthcare Quality:

1. read the CE-designated article(s), 2. circle the correct answers on the corresponding “answer sheet(s)”, and 3. submit this order form, the answer sheet(s) and the appropriate testing fee ($12 per article for

CAHQ members, $17 per article for non-members) to the address below. Articles remain available for CE credit in the Journal and on the CAHQ web site www.cahq.org for up to 2 years from the date of publication. Upon successful completion of the steps above, you will receive a certificate in the mail within 4 weeks of our receipt. For a RUSH CEU certificate by FAX or e-mail, enclose an additional $10.00 with your submission. Your certificate will be faxed or e-mailed to you within 3 working days of receipt. Name: _____________________________________________________________________ Address: ___________________________________________________________________ City: __________________________________________State: _____Zip: _______________ Phone (H): _____________________________Phone (W): ___________________________ Fax: _______________________________ e-mail:_________________________________ Professional License #: _________________________ Mail, fax or e-mail to: Examination Reviewer, CAHQ Education Committee

4570 Van Nuys Blvd. #326, Sherman Oaks, CA 91403 800-230-3163 or 562-212-1067, FAX 866-722-3277, e-mail CAHQmanager@cahq.org

Make checks payable to CAHQ. Sorry, a credit card payment option is not available for this activity. CE Fees: CAHQ members $12.00 per article; Non-CAHQ members $17 per article # of articles submitted _____ X $______ = Total CE fee $____________.00 $10.00 ADDITIONAL "RUSH" fee $____________.00 Total enclosed $____________.00

For Rush orders, send my certificate by □ FAX or □ e-mail (see above) REV 04/11