Fillable HITM Application Form

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HITM Application Form

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Page 1 of 6
LARAMIE COUNTY COMMUNITY COLLEGE
HEALTH INFORMATION TECHNOLOGY AND MANAGEMENT
Application Instructions
Thank you for your interest in the Laramie County Community College Health Information
Technology and Management program.
Please ensure that you fill out this application in its entirety. Failure to do so will result in
your application not being accepted for review.
The following items must be complete upon submission of your application:
Acceptance to LCCC within the last semester
Complete HIT/M application
Complete written interview
Agree to complete the drug screen and background check prior to beginning any HIT or
MEDC courses
Read and understand the HITM Program Handbook for Students
Provide required signature
Laramie County Community College
HITM Program HS 228
1400 E. College Drive
Cheyenne, WY 82007
Email: hitm@lccc.wy.edu
Page 2 of 6
LARAMIE COUNTY COMMUNITY COLLEGE
HEALTH INFORMATION TECHNOLOGY AND MANAGEMENT
Summary of Positions
Please review the position summaries below:
Summary for Medical Secretaries, 43-6013.00*
Perform secretarial duties using specific knowledge of medical terminology and hospital, clinic, or
laboratory procedures. Duties may include scheduling appointments, billing patients, compiling and
recording medical charts, reports, and correspondence.
Summary for Medical Records and Health Information Technicians, 29-2071.00*
Compile, process, and maintain medical records of hospital and clinic patients in a manner consistent
with medical, administrative, ethical, legal, and regulatory requirements of the health care system.
Process, maintain, compile, and report patient information for health requirements and standards in a
manner consistent with the healthcare industry's numerical coding system and privacy laws.
Summary for Medical Coders, 29-2071.00*
Medical coders review medical record documentation and assign codes for diagnoses and procedures using
standard classification systems including CPT, ICD-10-CM/PCS, and HCPCS Level II. Skills include knowledge of the
human body and disease processes and coding guidelines and conventions. Other duties include verification of
the work that was carried out during the visit, the quality of physician documentation and abstraction of important
data like physician names, dates of procedures, and insurance carrier.
The applicant must possess the ability to work with patients, family members, and medical
professionals; possess the ability to document, in writing, all relevant information in a format that fits
the standard of a medical office; possess the ability to write and converse in English with co-workers
and medical staff.
The candidate must possess good manual dexterity and the ability to perform tasks related to the
delivery of the highest quality of patient care; must possess the ability to bend and stoop as well as lift
up to 35 pounds; must be able to type, sit, stand for long periods of time.
*National Center for O*NET Development. O*NET Online. Retrieved March 2, 2018, from https://www.onetonline.org/.
Page 3 of 6
LARAMIE COUNTY COMMUNITY COLLEGE
HEALTH INFORMATION TECHNOLOGY AND MANAGEMENT
Applicant Information Details
APPLICANT INFORMATION
Name (First, MI Last): Full-time Part-time Undecided
SSN:
Phone:
LCCC Student ID#:
Male Female
Current Address:
E-Mail:
Please use a personal email address. Please do not use a school/work email address
as emails will be blocked and you will not receive communication from LCCC.
City:
State:
ZIP Code:
Program Goals:
MEDICAL EXPERIENCE (If Applicable)
Name & Location of Facility
1.
2.
3.
4.
Do you hold any current certifications? Yes No
Name:
CRIMES AGAINST A PERSON, FELONY STATEMENT AND LICENSING ACTION
Have you ever been convicted of a crime against a person? Yes
No
Have you ever been convicted of a felony?
Yes No
Have you ever been subjected to limitation, suspension, or termination of a health care occupation
Or voluntarily surrendered a health care license in any state or to an agency authorizing the legal right to work?
Yes
If you answered “yes” to any of the questions above, please provide details below.
You must also provide official documentation of the current status and disposition of the case.
No
Page 4 of 6
APPLICATION ACKNOWLEDGEMENTS
By checking this box and signing this application by typing my name in the signature box below, I hereby
certify that this application contains no willful misrepresentation or falsification and that the information
given by me is true and complete to the best of my knowledge and belief. I am aware that should an
investigation at any time disclose any misrepresentation or falsification, my application may be rejected,
denial to enter in, or removal from the program, or I may be dismissed from Laramie County Community
College.
By checking this box and signing this application by typing my name in the signature box below, I
understand information may be released to support current or future research projects associated with
the HITM program.
By checking this box and signing this application by typing my name in the signature box below, I
acknowledge I have read and understand the Position Summaries of an HITM employee. I understand
that being accepted in this program does not guarantee an employer will make an accommodation for
employment. Future employers have the right to set standards within their facilities and employment
decisions are at the sole discretion of each individual facility.
By checking this box and signing this application by typing my name in the signature box below, I
acknowledge I understand I must complete and pass a background check and drug screen prior to
beginning any HITM courses. I understand if I have further questions I will consult the Health Science &
Wellness Division Policy (PDF ) for allied health students.
By checking this box and signing this application by typing my name in the signature box below, I
acknowledge I read and understand the Health Information Technology/Management Program Policy
Handbook for Students.
Signature:
Date:
Non-Discrimination Statement
Laramie County Community college is committed to providing a safe and nondiscriminatory employment and
educational environment. The college does not discriminate on the basis of race, color, national origin, sex,
disability, religion, age, veteran status, political affiliation, sexual orientation or other status protected by law.
Sexual harassment, including sexual violence, is a term of sex discrimination prohibited by Title IX of the
Education Amendments of 1972. The college does not discriminate on the basis of sex in its educational,
extracurricular, athletic or other programs or in the context of employment.
Page 5 of 6
WRITTEN INTERVIEW
1. What reasons/experiences attracted you to a career in HIT/M?
2. Online, college-level programs require a great deal of self-study and effective time management skills.
Describe how you will organize your time to study and meet deadlines. What barriers exist that you
will need to overcome while in the HIT/M program?
3. We have a limited class size, why should we accept you into the program over someone else?
4. Briefly describe your work experience, volunteer or compensated. What skill or ability would you
highlight as your greatest strength?
Page 6 of 6
Any questions or concerns feel free to contact:
Ann Howard, MHA, RHIA, CCS
Program Director
ahoward1@lccc.wy.edu
307.432.1686
PLEASE READ THE INSTRUCTION SECTION OF
THIS APPLICATION PACKET BEFORE
SUBMITTING TO ASSURE IT IS COMPLETE.
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HITM Application Form

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Completed 14 February 2020

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