If you find anything in error, please contact Marc Nuar (mnuar@emory.edu).
Application Information
Application Name:
Application Owner:
Application Technical Contact:
Application Support Model:
Application Administration Model:
Application Description:
Application Marketplace ID/Link:
ServiceNow Request | Distribution Status & Date | Internal Review Status & Date | ePHI Indicator | Target User Base |
---|---|---|---|---|
List current issues here. When an issue is resolved, document the resolution and date, and move the issue into the issue log.
Maintain a list of issues and their resolution.
Document the conditions under which the application would be subject to reapproval (e.g., collecting ePHI data when it did not previously).
Review Request Date | Office of Technology Transfer Review | Legal Counsel Review (if applicable) | Marketing & Communications Review | Compliance & Regulatory Review | IT Security Review | LITS HIPAA Security Review (if applicable) | Architecture Review (if applicable) |
---|---|---|---|---|---|---|---|
Approval artifacts and relevant documentation may be located here: (app Box folder link)