Form 2

QHIN Application

Part IV – Organizational Infrastructure and Legal Authority
The questions in this Part correspond to Part 4, Section I.4 of the QHIN Onboarding & Designation SOP.

Part I – Basic Applicant Information

Part II – Organizational Requirements

Part III – Exchange of Required Information and Ability to Perform Functions of a QHIN

Part IV – Organizational Infrastructure and Legal Authority

Part V – QHIN Privacy and Security Requirements

Part VI – Project Plan

Part VII - Background References

Part VIII - Attestation

Question 20.

By when will the Designated Network Governance Body meet the representation requirements of Part 4, Section I.4(f)(i) of the QHIN Onboarding & Designation SOP? If not at the time of Designation, please provide a plan, with timelines, in the project plan (Part VI of this application), specifying how you will comply with the requirements of Part 4, Section I.4(f)(i) and I.4(f)(ii) of the QHIN Onboarding & Designation SOP within twelve (12) calendar months following Designation and how you will fulfill the Governance Functions in the interim.

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