Part II – Organizational Requirements

The questions in this Part correspond to Part 4, Section I.1 of the QHIN Onboarding and 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 2.

Please provide evidence that the legal entity named in Part I of this application is validly organized, in good standing.

Note: You must provide the following information at a minimum:

  1. A copy of your organization’s charter or equivalent document issued by the Secretary of State, or similar government agency, for the jurisdiction in which you are legally organized or incorporated.
  2. A certificate of good standing, or similar document, issued by the relevant governmental authority for the jurisdiction in which your organization is domiciled and dated within ninety (90) days of the date of this application.
  3. A current copy of your organizing documents, such as Articles of Incorporation and Bylaws for a corporation or Articles of Organization and Operating Agreement for a limited liability company.

"*" indicates required fields

Hidden

Drop files here or
Accepted file types: xls, xlsx, pdf, doc, docx, Max. file size: 50 MB.
    Attestation: The organizing documents submitted by Applicant are current and complete.*

    Stay Connected

    Complete the form below and join our mailing list.