Signed Common Agreement

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 46.

Please attach a signed copy of the Common Agreement

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Accepted file types: xls, xlsx, pdf, doc, docx, Max. file size: 50 MB.

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