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 19.

Please provide the Designated Network Governance Body charter or equivalent policy. Please provide documentation to confirm that the Designated Network Governance Body has the authority to approve the Governance Functions Policies and participate in such Policies in a manner that meets the requirements of the QHIN Onboarding & Designation SOP. For more information on the documentation requirements, please see Part 4, Section I.4(d) of the QHIN Onboarding & Designation SOP.

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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 19.

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