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 30.

Please provide documentation of the Change Management Policy that meets the participation requirements in Part 4, Section I.4(g)(v) of the Onboarding and Designation SOP. Please confirm that the Change Management Policy has been, or will be, approved by the Designated Network Governance Body. If you do not have such documentation, then in your project plan (Part VI of this application), you must explain the steps you are taking to create such documentation prior to Designation.

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Attestation: By selecting this box, I attest the Change Management Policy has been, or will be, approved by the Designated Network Governance Body*
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Accepted file types: xls, xlsx, pdf, doc, docx, Max. file size: 128 MB.

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