Specialized Topics in Areas of Radiologic Sciences P.O. Box 2931 * Toledo, Ohio 43606 (419) 471-1973 E-mail: info@xrayhomestudies.com

Licensed GXMO/LSO Order Form for Continuing Education Products

****LICENSED GXMO INFORMATION**** **Beginning April 1, 2012, the Ohio Department of Health has approved self-learning (home study) products for license renewal. You no longer have to attend in person presentations! The advantages are as follows: You no longer have to be away from work and home for 2 days and have associated travel expenses. You may select either DVD, CD, hard copy booklets or published books books as listed below. You can order anytime in advance of the expiration date of your license. You do NOT have to stay in Radiation Protection & Safety anymore. You have a HUGE selection of NEW topics for your expanded knowledge base. Home studies are LESS expensive than in person presentations, especially if you're paying it YOURSELF. You may work at your leisure. No one has come anywhere near failing the post tests since it's OPEN BOOK! Employers do NOT need to rearrange their staff and patient schedules to accommodate conference time. Doctors & Nurses can get ONA and AMA CE credit by using our GXMO/LSO CE Order Form tab on the web site. Our staff is always available to assist with your personal needs. If you DO have a GXMO license and have ordered courses you want to complete again, please click on the Online CE Post Test Printing tab for details. How self-learning (home study) products work: You select either a DVD/ hard copy published booklet/published textbook or CD on a topic of interest for your needed CE credits. A single gxmo selection includes 1 study topic of your choice and 1 post test. You submit the order form with payment as check or money order. We fill the order the same day we receive it in the S.T.A.R.S. office. You complete the reading or watching of the content, select the answers on the post test and return the completed post test to the S.T.A.R.S. office for evaluation. You need to get a 75% or better to receive a certificate of completion. If you do not, we send the post test back to you for correction and re-evaluate it again at NO charge. It's an OPEN BOOK test. Don't get too EXCITED! You can do it successfully the first time!!

How to renew your GXMO license in Ohio: The Ohio Dept. of Health (ODH) requires a minimum of 12 continuing education credits (ceus) to be completed every 2 years (your biennium) BEFORE your license expires. You may do more than 12 ceus, but not less than 12 ceus, if you so choose. Ceus in excess of 12 cannot be carried over to the next biennium. You will receive a hard copy renewal notice by mail from the ODH 60 days BEFORE your license expires. It is your responsibility to amend your personal information to the ODH whenever you change your name, address or place of employment as soon as possible by using the ODH website or contacting the ODH by telephone at 614 752-4319 for assistance. Failure to receive an ODH notice is not an acceptable reason for failing to renew on time. You can add completion of clinical modules to your GXMO license on the ODH web site. Your ODH notice informs you that you may renew online or request a hard copy form from them. You must have your S.T.A.R.S. certificate(s) of completion immediately available when you renew since your course title(s), number of ceus, and ODH accreditation number(s) and date(s) of completion are printed on it. You can renew immediately when you receive your notice or you have 30 days to complete the renewal process and payment to the ODH after your license expires. Online renewal requires your credit card for payment. If you chose hard copy renewal, you may submit a check or money order. You and/or your employer can view your renewed license on line upon completion of the process. Problems that exist with renewal should be addressed to the ODH by calling for assistance. S.T.A.R.S. personnel are NOT responsible for your renewal. Please direct any questions or needed assistance with renewal to the ODH personnel. You may also want to check the ODH web site periodically for changes that may have occurred during your biennium. GXMOs must notify the ODH in writing within 30 days of any changes in the physician providing direct supervision. If your scope of practice changes (e.g. chiropractic to podiatric), a competency form must be completed and submitted to the ODH. The ODH website is: http://www.odh.ohio.gov/odhPrograms/rp/rlic/ristatus.aspx Email is: BRadiation@odh.ohio.gov

Orders & post tests are processed on the same day of receipt to the S.T.A.R.S. office. Original signed certificates with accreditation numbers are prepared and mailed out on the same day of receipt in the S.T.A.R.S. office. Others can share the sets by ordering additional Post Tests for the equivalent number of CE credits at a reduced fee! Group orders need to have names and optional social security numbers for each participant for our computerized database record-keeping. Misplaced/lost certificates will be replaced with a new original certificate for a $5 fee each upon written request when details are provided. Call the S.T.A.R.S. office at (419) 471 - 1973 or email us at info@xrayhomestudies.com. for information. Office hours are 9 a.m. - 5 p.m. Monday - Friday and 9 a.m. - 12 p.m. Saturday EST.

No. of Sets	The contents of each approved Ohio Department of Health set for individual GXMO use includes the media you prefer as DVD, CD, Booklet and/or Book format choices and 1 post test! Additional hard copy post tests can be ordered for other GXMOS at a reduced fee if the media is shared.	NO. OF C.E.U.s	Cost per Set
	Radiologic Physics & Protection Series includes a DVD with audio and visual format that can be played on your TV/DVD equipment or on a computer. (includes 1 DVD and 1 test)	12	$150
	Additional Hard Copy Post Test		$90
	Additional DVD	1 copy	$50
			$0
	Radiologic Physics & Protection Series includes a HARD COPY BOOKLET for easy reading! (includes 1 booklet and 1 post test)	12	$165
	Additional Hard Copy Post Test		$90
	YOU CAN MIX AND MATCH TO GET THE REQUIRED 12 CE CREDITS FOR YOUR LICENSE RENEWAL!
	Digital Imaging Principles Unit (includes 1 booklet and 1 post test)	2	$35
	Additional Hard Copy Post Test		$20
	Radiation Protection for Our Patients, Our Co-workers & Ourselves (includes 1 booklet and 1 post test)	2	$35
	Additional Hard Copy Post Test		$20
	Understanding Exposure Factors: Density, Contrast, Detail, Distortion & Accessories (includes 1 booklet and 1 post test)	4	$60
	Additional Hard Copy Post Test		$35
	Patient Care and Education (includes 1 booklet and 1 post test)	4	$60
	Additional Hard Copy Post Test		$35
	How Radiation Affects Our Patients' and Our Bodies (includes 1 booklet and 1 post test)	4	$60
	Additional Hard Copy Post Test		$35
	Interpersonal Communication for Patients of All Ages & Between Men and Women (includes 1 booklet and 1 post test)	1.5	$15
	Additional Hard Copy Post Test		$10
	The units LISTED BELOW are designed for continuing education and do NOT replace clinical competency modules since there are no in person demonstrations, simulations and use of equipment.
	Chest & Abdomen Anatomy, Terminology & Positioning Unit (includes 1 booklet and 1 post test)	4	$60
	Additional Hard Copy Post Test		$35
	Podiatric Anatomy, Terminology & Positioning Unit (includes 1 booklet and 1 post test)	4	$60
	Additional Hard Copy Post Test		$35
	Spine/Chiropractic Anatomy, Terminology & Positioning Unit (includes 1 booklet and 1 post test)	4	$60
	Additional Hard Copy Post Test		$35
	Skull, Facial Bones & Sinuses Anatomy, Terminology & Positioning Unit (includes 1 booklet and 1 post test)	4	$60
	Additional Hard Copy Post Test		$35
	Extremities Anatomy, Terminology & Positioning Unit (includes 1 booklet and 1 post test)	6	$75
	Additional Hard Copy Post Test		$50

These CD self-learning home study products are approved for the Ohio Department of Health for GXMO License Renewal.
	Image Analysis CD format with 1 post test	4	$50
	Additional Hard Copy Post Test		$35
	Ohio Dept. of Health Site Visit Preparation CD format with 1 post test. This unit is NOT on CD format for single users and will be sent as hard copy. It is combined with Image Analysis on a CD for 5 ce credits.	1	$15
	Additional Hard Copy Post Test		$10
	Combination CD of both Image Analysis and ODH Site Visits with 1 post test.	5	$55
	Additional Hard Copy Post Test		$40

These TEXTBOOK self-learning home study products are approved by the Ohio Department of Health for licensed GXMOs. Cover Photos of these textbooks are on the Post Test Printing tab.
No. of Sets	Contents of Each Set for Individual Use includes 1 Post Test! Others can Share the Sets by Ordering Additional Post Tests for the Equivalent Number of CEUS! Easy to Read Books!	NO. OF C.E.U.s	Cost per Set
	Radiologic Physics & Protection Series - Part 1 (includes printed copy of book and test)	6.5	$65
	Additional Hard Copy Post Test		$50
	Radiologic Physics & Protection Series - Part 2 (includes printed copy of book and test)	3.5	$45
	Additional Hard Copy Post Test		$30
	Trauma and Mobile Radiography by Drafke and Nakayama Great resource & refresher for urgent care & hospital environment! (includes printed copy of book and test)	12	$150
	Additional Hard Copy Post Test		$90
	Cliff`s Quick Review Anatomy & Physiology (includes printed copy of book and test)	12	$150
	Additional Hard Copy Post Test		$90
	Radiation Protection in Medical Radiography by Mary Alice Statkiewicz, et. al. (includes printed copy of book and test)	17	$150
	Additional Hard Copy Post Test Note: Please identify the edition of the textbook you will be using so that the post test questions will match your book. The edition is printed on the cover of the book: ( ) SIXTH EDITION or ( ) SEVENTH EDITION		$90
	Medical Terminology Made Incredibly Easy! by Wolters Kluwer. (includes printed copy of book and test)	14.5	$150
	Additional Hard Copy Post Test Note: Please identify the edition of the textbook you will be using so that the post test questions will match your book. The edition is printed on the cover of the book: ( ) THIRD EDITION or ( ) FOURTH EDITION		$90

Shipping Please address/send overnight/express mail to me personally at my home address with no signature required. Please use United States Postal Service, UPS or DHL. Do not use FEDEX because they do not do home delivery on Sundays and Mondays. Please call me at 419-471-1973 for details. Please include a work or home telephone number if you need to be contacted about the results of your post tests or certificate accreditation numbers if you are on a critical deadline. $15 per 1-2 items, 2-3 day delivery - The flat rate priority fee is charged because a tracking number is provided on the      envelope and receipt in case of lost or delayed delivery; the card stock envelope minimizes damage to the contents;      and the 2-3 day delivery accommodates gxmos who are on serious deadlines.      3 or more items will require additional $15 shipping & mailing fees to cover the extra mailing envelopes that will be      included by the automatic calculator.

Total:

Note: If our calculator does not work on your personal computer, please hand total and remember to include the $15 priority shipping & delivery per 1-2 items.

Misplaced/lost certificates will be replaced with a new original certificate for a $5 fee each upon written request when details are provided. Please submit your payment as check or money order to the STARS office with your order form. Please add $15 for priority shipping & handling for 1-2 items and an additional $15 for more copies. *No refund will be given for cancelled orders or in-completion of a self-learning/ home study product. Carolyn J. Frigmanski, M.A.,B.S.R.T. ® c/o S.T.A.R.S. P.O. Box 2931 Toledo, Ohio 43606 No credit card, fax or telephone orders accepted due to the risk of identity theft!

You will receive a signed certificate for each course you complete. Remember, you will get your license renewal letter from the ODH BEFORE your license expires. It is YOUR responsibility to complete the renewal application because YOU must confirm your name, current address & employment, proof of continuing education and payment to the ODH. I CAN NOT do this activity for you.

None of the information provided here will be transmitted over the Internet.
NAME
ADDRESS
CITY	STATE
ZIP
DATE
EMAIL
HOME PHONE
WORK PHONE
DESIRED NO. for record keeping *:  (single person order)

*No refund will be provided for cancelled orders or incompletion of a self-learning/ home study product.

* The complete or partial SSN is optional in the DESIRED NO. box on this order form, but is recommended for the post test certificate creation. You may substitute with your GXMO or ONA License Number or LSO number, if applicable.

If multiple people are ordering as a group, please identify
each participant and desired number.

Name Desired No. *   1.       2.       3.       4.       5.       6.

  

Don't forget: Non-licensed applicants/employees in Ohio can use the GXMO Training tab for a self/learning (home study) course. Licensed gxmos and non-licensed applicants/employees can use the Clinical Training in Ohio tab for clinical modules that may be scheduled with vacancies available for others to join or to find out details about hosting your own clinical course in YOUR practice with no additional expense! Licensed gxmos can acquire CE credits toward their 12 CE requirement for license renewal when completing a module(s). Licensed gxmos can use the GXMO/LSO CE Order Form tab for a self/learning (home study) course. Please share our S.T.A.R.S. educational services with others. Thank you very much!