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  • Internal App Approval Details - Template

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If you find anything in error, please contact Marc Nuar (mnuar@emory.edu).

Application Information

Application Name:

Emory Application Owner:

Emory Application Technical Contact:

Application Support Model: 

Application Administration Model:

Application Description:

Application Marketplace ID/Link:

ServiceNow RequestDistribution Status & DateInternal Review Status & DateePHI IndicatorTarget User Base
     


 

Current Issues

List current issues here.  When an issue is resolved, document the resolution and date, and move the issue into the issue log.

Issue Log

Maintain a list of issues and their resolution.

 

Reapproval Conditions

Document the conditions under which the application would be subject to reapproval (e.g., collecting ePHI data when it did not previously).

 

Internal Review Status: complete or incomplete

Internal Distribution Request DateCompliance & Regulatory ReviewIT Security Review
   


Collateral

Upload collateral as it is collected.

Approval Artifacts

Upload approval artifacts as they are collected.  Approval artifacts and relevant documentation may be found here: (app Box folder link)  

  1. Compliance and Regulatory Review.
  2. IT Security Review Questions.
  3. Distribution Review Checklist.