Online Education Modules & Courses Facility Order Form FACILITY INFORMATION Facility Name: Business Address 1: Business Address 2: City: State/Province: Postal Code: Country: Phone: Health Care System: ADMINISTRATOR/CONTACT INFORMATION First Name: Last Name: Credentials: Title: Business Address 1: Business Address 2: City: State/Province: Postal Code: Country: Phone: Email: AORN ID: ORDER DETAILS ASEPTIC PRACTICE MODULES PRICE QTY. Total $ Preoperative Skin Antisepsis $95 Scrubbing, Gowning, and Gloving $95 Sterile Technique $95 The Perioperative Environment $95 Surgical Draping $95 EQUIPMENT AND PRODUCT SAFETY MODULES PRICE QTY. Total $ Endoscopic and MIS $95 Perioperative Safety: Equipment Focus $95 Perioperative Safety: Introduction $95 Safe Use of Surgical Energy $95 PATIENT CARE MODULES PRICE QTY. Total $ Anesthesia $95 Medications and Solutions $95 Perianesthesia Nursing $95 Perioperative Assessment $95 Positioning the Surgical Patient $95 Individual Modules: page 1 of 5
ORDER DETAILS (Cont d) PATIENT AND WORKER SAFETY MODULES PRICE QTY. Total $ Environmental Sanitation and Terminal Cleaning $95 Hemostasis, Sponges, and Drains $95 Patient and Family Education $95 Perioperative Safety: Patient Focus $95 Specimens $95 Transmissible Infection Prevention $95 Wound Closure $95 Wound Healing $95 STERILIZATION MODULES PRICE QTY. Total $ Sterilization and Disinfection $95 Surgical Instruments $95 GENERAL MODULES PRICE QTY. Total $ Clinical Reasoning $95 Perioperative Health Care Information Management $95 Professionalism $95 Introduction to the PNDS Free Certificate in the Fundamentals of Evidence-Based Practice $35 Prep for CNOR Online $195 Medication Safety Assessment $55 Guideline Assessment $55 SPECIALTY MODULES & COURSES PRICE QTY. Total $ Safe Administration of Moderate Sedation $200 Care of the Pediatric Patient in Surgery $110 Preceptor Certificate Program $179 Laser Safety $110 AMBULATORY SURGERY CENTER MODULES & COURSES PRICE QTY. Total $ ASC Infection Prevention $195 Onboarding for the ASC $110 Preoperative Care in the ASC $95 Postoperative Care in the ASC $95 FINANCIAL MODULES PRICE QTY. Total $ Nursing Leadership Resources: Budgeting $55 Nursing Leadership Resources: Statistics $55 Nursing Leadership Resources: Financial Statements $55 BULK PURCHASE DISCOUNT* Apply the following discount: 11-29 modules and/or courses - 5% 30+ modules and/or courses - 10% Less discount (if applicable) $ ( ) TOTAL AMOUNT DUE: $ *Excludes Prep for CNOR Individual Modules: page 2 of 5
PAYMENT INFORMATION FOR SECURE PROCESSING, ORDERS WILL ONLY BE ACCEPTED VIA SECURE FAX OR MAIL. EMAIL SUBMISSIONS WILL NOT BE ACCEPTED. Payment Type: Credit Card: See last page to complete card payment form. Check ORDER PROCESS 1. Complete order form and submit with payment to AORN (a purchase order is not considered payment). 2. Order will be processed and agreement activated after AORN receives both completed order form and payment. 3. Administrator(s)/contact will receive the registration email. By signing or typing my name below, I agree to the AORN Terms and Conditions for this purchase and any future purchases. If the product purchased is for use by my facility, I am authorized by my facility to bind my facility to the terms of this agreement. Type or sign here: Date: MAIL OR FAX ORDER FORM: AORN Experience Services 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711 Secure Fax: 844-241-4050 QUESTIONS? Contact Experience Services US Phone: 1-800-755-2676 International Phone: 303-755-6300 FOR OFFICE USE ONLY Version: 10-17 Individual Name: Account #: Individual Modules page 3 of 5
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Online Education Modules & Courses Facility Order Form CREDIT CARD PAYMENT FORM FOR SECURE PROCESSING, ORDERS WILL ONLY BE ACCEPTED VIA SECURE FAX OR MAIL. EMAIL SUBMISSIONS WILL NOT BE ACCEPTED. ORDER PROCESS 1. Complete order form and submit with payment to AORN (a purchase order is not considered payment). 2. Order will be processed and agreement activated after AORN receives both completed order form and payment. 3. Administrator(s)/contact will receive the registration email. Credit Card Type: Visa MasterCard American Express Discover Credit Card Number: Expiration Date: CVV: Credit Card Holder Name: Signature: Purchasing Agent Name (if different from credit card holder): Phone: Total Amount Paid $: MAIL OR FAX ORDER FORM: AORN Experience Services 2170 S Parker Rd, Suite 300 Denver, CO 80231-5711 Secure Fax: 844-241-4050 QUESTIONS? Contact Experience Services US Phone: 1-800-755-2676 International Phone: 303-755-6300 FOR OFFICE USE ONLY Version: 12-16 Individual Name: Account #: Individual Modules page 5 of 5