STUDENT EVALUATION FORM

Instructions: Student’s Name:______Student ID#: K______1) Complete all fields with course information that you would like considered. PLEASE TYPE DIRECTLY INTO THE FORM. 2) Submit the completed form to the Transcript Date:______PipelineEvaluation Office, SBCC, 721 Cliff Drive, Santa Barbara, Email CA Address:[email protected] 93109. 3) Official transcripts must accompany this form OR must be on file in Admissions. 4) Incomplete course information will lead to a Otherdenial Collegesof coursework. Attended:______5) You will receive the evaluation results at your SBCC Pipeline email within 2-6 weeks. 6) Questions can be addressed to [email protected]

HEALTH INFORMATION TECHNOLOGY Course Name & Type Term ASSOCIATE IN SCIENCE DEGREE 2011-12 Number Course Title (sem. (F07, or S08 or HIT Department Requirements Institution Name (Ex: HIT 135) (Ex: Medical Terminology) Grade Units quart.) SU08) COMP 101 Microsoft Office 4.0 sem. HIT 135 Medical Terminology 3.0 sem. BMS 146 Human Form and Function 3.0 sem. HIT 101 Intro. to Health Information Mgmt 3.0 sem. HIT 102 Legal Aspects of Healthcare 3.0 sem. HIT 204 Basic Pathophysiology 3.0 sem. HIT 201 Pharmacology for Allied Health 2.0 sem. HIT 200 ICD-9-CM Coding 3.0 sem. HIT 210 CPT Coding 3.0 sem. HIT 255 Medical billing and 4.0 sem. Reimbursement HIT 220 Health Care HIM Statistics 2.0 sem. HIT 240 Quality Healthcare Management 3.0 sem. HIT 230 Alternative Delivery Systems 2.0 sem. HIT 265 HIM Computer Applications 2.0 sem. MGMT 101 Intro to Management 3.0 sem. HIT 275 HIT Practicum 3.0 sem.

HEALTH INFORMATION TECHNOLOGY Type Term ASSOCIATE IN SCIENCE DEGREE 2011-12 Course Name & (sem. (F07, or S08 or Number Course Title Grade Units quart.) SU08) General Education Requirements Institution Name (Ex: PSY 100) (Ex: General Psychology) A. Natural Science with lab 4.0 sem. B. Social and Behavioral Science 3.0 Examples: Psychology, History, Sociology sem. C. Humanities 3.0 Examples: Art Appreciation, Music History, Film sem. Appreciation, Philosophy, Foreign Language (Hands-on Art or Music classes are not accepted) D-1. English Composition 3.0 Must be Freshman Composition, university-level. sem. BA/BS degree meets requirement. D-2. Communication and Analytical Thinking 3.0 Math course will double count for this requirement sem.

E-1. Elementary Algebra Opt. 1 Only available to students who were enrolled in Spring 09 or Summer 09 & who stay enrolled each Fall & Spring until graduation.

E-1. Intermediate Algebra Opt. 2 Choose 3 out of 4 of areas E-2 through E-5: E-2. American Institutions 3.0 US History or American Government sem. E-3. PE/Health 2-4 2 units of PE activity OR 1 unit PE activity + 3-unit sem. personal health course E-4. Oral Communication 3.0 Speech, Interpersonal or Group Communication sem. E-5. Multicultural/Gender Studies 3.0 Central theme of course is non-western or women's sem. studies. Examples: Cultural Anthropology, Comparative Religions, Intercultural Communications, Nonwestern Art, World Music F. Information Competency 1.0 Research and information literacy course sem. Counselor Comments:

Counselor Signature: Date: