Get Upmc Participation Agreement For Electronic Health Record Technical Assistance

This guide provides a comprehensive overview of how to complete the UPMC Participation Agreement For Electronic Health Record Technical Assistance online. Designed for users of all experience levels, this guide will help you navigate each section of the agreement with confidence.

Follow the steps to complete the form effectively.

1. Use the ‘Get Form’ button to access the agreement. This action will initiate the process to retrieve the document for completion.
2. Begin with the first section titled 'Provider Organization.' Fill in the name of the provider organization, including tax identification information and primary contact details. Ensure accuracy in all entries to facilitate the agreement process.
3. Next, move to the demographic information section in Exhibit A. Complete fields regarding the organization type and patient demographics, including percentages of Medicaid patients served.
4. As you fill out the site locations, list all practice locations accurately, including addresses and contact information. Attach additional sheets if necessary for multiple sites.
5. Continue to the participating providers section. Include detailed information for each provider, such as name, license type, specialty, and primary location. This ensures all relevant providers are acknowledged in the agreement.
6. In Exhibit B, provide documentation of time spent by providers and administrative staff on EHR implementation and meaningful use. This documentation supports the cooperative agreement with HHS.
7. Review the general terms outlined in the agreement to understand mutual responsibilities and termination policies. Ensure you agree to these terms before proceeding.
8. Finally, upon completion of all fields, review the entire agreement for any errors. Save changes, and choose to download, print, or share the completed form as needed.

Complete your documents online today for a smoother process in enhancing your electronic health record capabilities.