Form 2

QHIN Application

Part III – Exchange of Required Information and Ability to Perform Functions of a QHIN
The questions in this Part correspond to Part 4, Sections I.2 and I.3 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 9.

Please describe how your experience and resources – including technical, governance, legal, operational, and financial – for your current network will be leveraged in connection with the Designated Network if it is different from your current network.

*You may respond with information regarding your Parent’s Current Network provided that you are a wholly-owned subsidiary of such parent entity.

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