TrueHLTH + Umbra Directory Listings Terms: $129/year (Auto-renews unless cancelled before the renewal date) Terms: $129 / Year First Name:* First Name Required Last Name:* Last Name Required Address:* Address is Required City:* City is Required State or Province:* State or Province is Required Zip or Postal Code:* Zip or Postal Code is Required Country: Country is not valid USA Canada Other Country (Outside US and Canada): Country (Outside US and Canada) is not valid Phone number:* Phone number is Required Email (to match for renewal):* Email (to match for renewal) is Required Do you hold any of these certifications?:* Do you hold any of these certifications? is Required Board-Certified Patient Advocate (BCPA) Certified Senior Advisor (CSA) Certified Life Care Planner (CLCP) Certified Geriatric Care Manager (CGCM) Certified Medical Coder (CMC) Certified Case Manager (CCM) Social Worker (LCSW, MSW) Registered Nurse (RN) Certified Nurse Practitioner (CNP) Physicians Assistant (PA) Medical Doctor (MD) Pharmacist (PharmD) Occupational Therapist (OT) Physical Therapist (PT) Chiropractor (DC) Medical Assistant (CMA) Certified Nurse Assistant (CNA) Other None of the Above Where did you hear about the Alliance of Professional Health Advocates?: Where did you hear about the Alliance of Professional Health Advocates? is not valid Your experience (Please check all that apply):* Your experience (Please check all that apply) is Required I have worked in a healthcare administrative role I have worked in a healthcare clinical role I have been an unpaid caregiver I have been a non-clinical paid caregiver I have had training in patient advocacy/care management/care coordination None of the above Which of the following do you have experience doing? (Please check all that apply):* Which of the following do you have experience doing? (Please check all that apply) is Required Managing health insurance and/or pharmacy benefit issues such as prior/pre authorization, step therapy, denials/appeals, and/or filing medical claims Scheduling appointments, arranging transportation, care coordination, tracking paperwork/records Communicating with medical/service providers, patient education Navigating for additional financial or other assistance (e.g. Disability) for those in need Managing/reducing hospital bills Other If other, please specify:: If other, please specify: is not valid Do you have experience advocating for patients with inflammatory bowel disease (IBD), including Crohn’s and/or ulcerative colitis?:* Do you have experience advocating for patients with inflammatory bowel disease (IBD), including Crohn’s and/or ulcerative colitis? is Required Yes No If yes, please describe your experience with IBD navigation/advocacy: If yes, please describe your experience with IBD navigation/advocacy is not valid If no, are you willing to complete APHA/Umbra training module/s on IBD specifically?:* If no, are you willing to complete APHA/Umbra training module/s on IBD specifically? is Required Yes No Please include your bio or a link to an online bio for you. Either keep it brief (up to 150 words) or include your full bio and we will trim it for you.: Please include your bio or a link to an online bio for you. Either keep it brief (up to 150 words) or include your full bio and we will trim it for you. is not valid Do you have Professional Liability / Errors and Omissions insurance?:* Do you have Professional Liability / Errors and Omissions insurance? is Required Yes No Has there been a claim against you in the past seven years?:* Has there been a claim against you in the past seven years? is Required Yes No If Yes, please explain: If Yes, please explain is not valid Do you have knowledge or information of any act, error, or omission which might reasonably be expected to give rise to a claim against you?:* Do you have knowledge or information of any act, error, or omission which might reasonably be expected to give rise to a claim against you? is Required Yes No If Yes, please explain: If Yes, please explain is not valid Have you ever been turned down (declined) for Errors & Omissions or Professional Liability insurance?:* Have you ever been turned down (declined) for Errors & Omissions or Professional Liability insurance? is Required Yes No If Yes, please explain: If Yes, please explain is not valid Have you ever had Errors & Omissions or Professional Liability insurance that was canceled?:* Have you ever had Errors & Omissions or Professional Liability insurance that was canceled? is Required Yes No If Yes, please explain: If Yes, please explain is not valid Have you ever been the subject of disciplinary or investigative proceedings or reprimand by a governmental or administrative agency, hospital or professional association?:* Have you ever been the subject of disciplinary or investigative proceedings or reprimand by a governmental or administrative agency, hospital or professional association? is Required Yes No If Yes, please explain: If Yes, please explain is not valid Have you ever been convicted for an act committed in violation of any law or ordinance other than traffic offenses?:* Have you ever been convicted for an act committed in violation of any law or ordinance other than traffic offenses? is Required Yes No If Yes, please explain: If Yes, please explain is not valid Have you ever had any state professional license or license to prescribe or dispense narcotics refused, suspended, revoked, renewal refused or accepted only on special terms or ever voluntarily surrendered the same?:* Have you ever had any state professional license or license to prescribe or dispense narcotics refused, suspended, revoked, renewal refused or accepted only on special terms or ever voluntarily surrendered the same? is Required Yes No If Yes, please explain: If Yes, please explain is not valid What is your hourly rate?:* What is your hourly rate? is Required What will you charge for 5 hours of time? (We’d like to offer discounts for clients who sign up for larger blocks of time.):* What will you charge for 5 hours of time? (We’d like to offer discounts for clients who sign up for larger blocks of time.) is Required What will you charge for 10 hours of time? (We’d like to offer discounts for clients who sign up for larger blocks of time.):* What will you charge for 10 hours of time? (We’d like to offer discounts for clients who sign up for larger blocks of time.) is Required I have read and agree to the Consumer Health Advocacy, Inc. Advocate Terms and Conditions and Service Level Agreement, including the HIPAA Agreement.* Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger Have a coupon? Coupon Code: Invalid Coupon Coupon applied successfully No val Please fix the errors above
