Get Md Addendum To Crisp Participation Agreement And Qualified Services Organization Agreement 2017-2025

Filling out the MD Addendum To CRISP Participation Agreement And Qualified Services Organization Agreement is a crucial step for facilities that provide substance use disorder services. This guide will provide clear instructions to help users complete this document online efficiently.

Follow the steps to complete the MD Addendum online.

1. Click the ‘Get Form’ button to access the document and open it in the designated editing interface.
2. Begin by entering the name of your organization in the blank space following 'between Chesapeake Regional Information System For Our Patients (CRISP) and ________________ (the Program)'. This identifies the participating organization.
3. Review the provided definitions in Section I, which clarify important terms such as 'Part 2 Information' and 'Consent'. Familiarize yourself with these definitions to ensure proper understanding as you move forward.
4. In Section II 'Services To Be Performed', describe the specific Part 2 Information your program will provide to CRISP. Be precise and ensure that it aligns with the necessary demographic panels of current patients.
5. Confirm compliance with all provisions of the CRISP Participation Agreement outlined in Section II. Explain how your program will adhere to these terms and the specific agreed-upon services or use cases.
6. In Section III 'Compliance with 42 C.F.R. Part 2', acknowledge CRISP's responsibilities regarding Part 2 Information. Ensure that you understand the compliance obligations and the necessity of protecting patient information.
7. Review the additional terms in Section IV, confirming your understanding of the addendum’s termination provisions and other legal terms.
8. At the end of the document, provide the names and titles of the individuals authorized to sign on behalf of both your organization and CRISP. Ensure all required signatures are obtained.
9. Once all fields are completed, save your changes. You have the option to download, print, or share the finalized document as needed.

Complete your MD Addendum online to ensure compliance and effective communication with CRISP.