Get Eligibility Extension Brequest Formb - Ahima

This guide aims to assist users in completing the Eligibility Extension Request Form for AHIMA effectively. Whether you are familiar with the process or new to it, this step-by-step framework will ensure all necessary information is accurately provided.

Follow the steps to complete your form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your AHIMA ID number in the designated field. Ensure this is accurate to avoid any processing delays.
3. Select your exam type by checking the appropriate box for CCA, CCS, CCS-P, RHIA, RHIT, CHPS, CHDA, or CDIP.
4. Choose the type of extension you are requesting: either the 1st Request for Extension for $75.00 or the 2nd and Final Request for Extension for $150.00. Each option has a specific validity period.
5. Fill in your personal information under Candidate Information, including your first name, middle initial, last name, suffix, address, city, state, zip code, country, home phone number, and email address.
6. Provide the Extension Request Date and Current Eligibility End Date in the required fields.
7. Select your method of payment by marking the appropriate option (VISA, MasterCard, or American Express).
8. Fill in your credit card number, the name as it appears on the card, expiration date, and the charge amount.
9. Add your signature to authorize the payment. Remember, you must cancel your exam appointment with Pearson VUE before the extension is authorized.
10. Review all entered information for accuracy and completeness before submitting. Once verified, you may save changes, download, print, or share the form as needed.

Ensure you complete your Eligibility Extension Request Form online and submit it promptly to avoid any issues.