Customer ServiceIn an effort to support medical providers and care team members utilize QHN efficiently this section of our web site contains QHN policies, forms and other resources that you may find useful.
Forms | Agreements | PoliciesQHN is committed to helping our medical partners and information providers comply with evolving policies and operating procedures for health information exchange, while safely and securely exchanging patient data for improved patient outcomes.
Many of the below forms are interactive PDFs, which allow you to complete the form by typing directly into the fields. We encourage you to use this feature as handwritten forms are often difficult to read and may lead to a delay in the QHN enrollment process.
Save form to your desktop prior to typing in any information, this will allow you to save and print the document.
These forms may be signed electronically and emailed directly to QHN at: email@example.com.
QHN User forms
- QHN New User Packet
- User Profile Form
- New User Form
- Change Request Form
- Request to Create Patient ID in QHN System
Behavioral Health Consent and Opt-out, Opt-in forms
- Mind Springs Health: Authorization for Disclosure of Health Information form
- The Center for Mental Health Authorization for Use and Disclosure of Health Information form
- QHN Patient Opt-Out Form
- QHN Patient Opt-In Form