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 15.

Please describe how your current network is governed. This must include a description of the individual/group responsible for governing your current network and how the governance is performed.

*You may respond with information regarding your Parent’s Current Network provided that you are a wholly-owned subsidiary of such parent entity.

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If you have a question at any time during the application process please feel free to contact the RCE team. We'll be happy to assist you.

Form 2

QHIN Application

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 15.

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