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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

Question 1 

Part II – Organizational Requirements

Question 2 Question 3

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

Question 4
Question 5
Question 6
Question 7
Question 8
Question 9
Question 10
Question 11
Question 12
Question 13

Part IV – Organizational Infrastructure and Legal Authority

Question 14 Question 15 Question 16 Question 17 Question 18 Question 19 Question 20 Question 21 Question 22 Question 23 Question 24 Question 25 Question 26 Question 27 Question 28 Question 29 Question 30 Question 31 Question 32 Question 33 Question 34

Part V – QHIN Privacy and Security Requirements

Question 35 Question 36 Question 37 Question 38 Question 39 Question 40 Question 41 Question 42 Question 43

Part VI – Project Plan

Question 44

Part VII - Background References

Question 45
Question 46

Part VIII - Attestation

Question 47

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: 50 MB.

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