*Due to space limitations, please plan to call in to one of the calls to save seats for everyone. Following the calls, a FAQ document will be posted on the website () that will include responses to questions from both calls. For questions, contact Michele Brown: Email: Telephone: 508 421 5919 Fax: 508 856 6650 Application Package Submission Checklist Check if Item Due Date complete Submit letter of intent to apply electronically to: CTCRI@umassmed.edu Wednesday, May 3 2017 Letter to include: Practice name, practice address, physician champion, application key contact name, email address and phone. If a multisite practice, indicate physician champion at each site Final Package for Submission Submit a Letter of support* from at one physician, nurse practitioner or physician assistant leader in the Tuesday, May 23, 2017 practice signed by all providers in the practice Practices that are part of an ACO must submit an ACO letter Tuesday, May 23, 2017 of support. Completed Application Package Checklist Tuesday, May 23, 2017 Completed Application Form Tuesday, May 23, 2017 Written response to essay questions Tuesday, May 23, 2017 Copy of sample standardized and a sample customized EHR report (if you have the capability) Tuesday, May 23, 2017 Please remove any protected health information (PHI) before submitting sample reports Copy of Meaningful Use attestation from one provider Tuesday, May 23, 2017 Completed application packages including completed checklist - should be received by 5:00 PM on Tuesday – May 23, 2017. Email application package to: CTCRI@umassmed.edu For questions, contact Michele Brown: Email: Telephone: 508-421-5919 Fax: 508-856-6650
*Due to space limitations, please plan to call in to one of the calls to save seats for everyone. Following the calls, a FAQ document will be posted on the website () that will include responses to questions from both calls. For questions, contact Michele Brown: Email: Telephone: 508 421 5919 Fax: 508 856 6650 Application Package Submission Checklist Check if complete Item Due Date Submit letter of intent to apply electronically to: CTCRI@umassmed.edu Letter to include: Practice name, practice address, physician champion, application key contact name, email address and phone. If a multisite practice, indicate physician champion at each site Wednesday, May 3 2017 Final Package for Submission Submit a Letter of support* from at one physician, nurse practitioner or physician assistant leader in the practice signed by all providers in the practice Tuesday, May 23, 2017 Practices that are part of an ACO must submit an ACO letter of support. Tuesday, May 23, 2017 Completed Application Package Checklist Tuesday, May 23, 2017 Completed Application Form Tuesday, May 23, 2017 Written response to essay questions Tuesday, May 23, 2017 Copy of sample standardized and a sample customized EHR report (if you have the capability) Please remove any protected health information (PHI) before submitting sample reports Tuesday, May 23, 2017 Copy of Meaningful Use attestation from one provider Tuesday, May 23, 2017 Completed application packages – including completed checklist - should be received by 5:00 PM on Tuesday May 23, 2017. Email application package to: CTCRI@umassmed.edu For questions, contact Michele Brown: Email: Telephone: 508-421-5919 Fax: 508-856-6650
CTC%20RI%202017%20Application%20PCMH%20Kids%205.16.17%20%20FINAL.docx