1. 3M Health Information Systems

3M Health Information Systems

3M On-demand Education Order Form

Below is the order form for our on-demand education series. All fields are required in order to process your order. The License Agreement must be accepted and agreed to prior to any order submission.

Important Information:

The person listed as the main point of contact on the form will receive all communication regarding access to the video content. Content will begin to be released in late August. The final schedule will be released no later than September 6th. 3M Support site access and accounts are necessary to view the videos. New customers will be emailed a unique 3M Site Identification number with instructions to create a 3M support account once their order has been processed. Please allow 5 business days to verify and process your order.

Upon completion of the education material, a verification form will be provided allowing users to submit for AHIMA CEU credits.

For any questions regarding this education or order form please email us and include your organization and phone number 3MHISConsultingServicesEducation@mmm.com


IP Address
*Today's date

Organization main point of contact

Please note the main point of contact will receive all communication on when and how to access content; for billing point of contact see below

*Is your organization a 3M Customer?

If 3M Customer please enter the 3M Site ID (To expedite your order, please enter the site ID that can be found on https://support.3mhis.com if you are a registered user. Otherwise contact your 3M sales representative to obtain it):

*Organization

*First Name:

*Last Name:

*Title:

*Email:

*Confirm Email:

*Phone:

*Address 1:

Address 2:

*City:

*State:

*Zip Code:

PO Number:

Total User Licenses (minimum order is 5)

This content is appropriate for coders, CDI professional, revenue cycle, compliance and auditors.
Please note: support site access is required to access the content.

Please ensure total users are correct. Minimum order is "five (5)" user licenses. Once contracted we cannot reduce the amount that is contracted.

*Total users:

TiersPrice per User60%50%
5 - 10$485 $243
11 - 20$470  $235
21 - 35$460  $230
36 - 50$450  $225
51 - 65$435$174 
66 - 80$425$170 
81 - 100$400$160 
Over 100$375$150 

Bill to InformationCheck here if same as main contact information

*First Name:

*Last Name:

*Email:

*Confirm Email:

*Phone:

*Address 1:

Address 2:

*City:

*State:

*Zip Code:

Signature

By typing your email address, you verify that you have purchasing authority at your facility to place this order or have obtained permission; you indicate that you have read and agree to the terms presented in the "LICENSE AGREEMENT - TERMS AND CONDITIONS"


*I have read and agreed with the License Agreement Terms and Conditions


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