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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.  

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

 

Application Information

Application Name:

Application Owner:

Application Technical Contact:

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.  

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

 

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