Documentation Checklist

Items Requiring Action

  • Complete and sign the Application Questionnaire
  • Complete the first sentence of the Participation Agreement
  • Sign the Participation Agreement
  • Complete the first sentence of the Provider/Supplier Addendum
  • Sign the Provider/Supplier Addendum
  • Complete the first sentence of the MSSP Addendum
  • Sign the MSSP Addendum
  • Complete first sentence of the Business Associate Agreement
  • Complete the "Notices to Participant" section of the Business Associate Agreement
  • Sign the Business Associate Agreement 

Participation Agreement PDF

Participation Agreement Participation Agreement (412 KB)