OhioHealth Clinically Integrated Network

1. If you are not currently a signed CliniSync participant, please click the link below to download a copy of the Participant Agreement. This agreement is a fillable PDF which allows for data entry, electronic signing, saving, and emailing.

CliniSync Participant Agreement

Please note:

• Information about your organization, Page 1
• Signature section, bottom of Page 2
• Additional services, Pages 6, 7, and 8
• BAA begins on Page 22, add your organization name as Participant
• Signature section, bottom of Page 25

*Once you have completed the form in its entirety via email to Karen Bishop (kbishop@ohiponline.org).*

2. If you partner with LabCorp, please click the following link to download a copy of the LabCorp – HIE Provider Authorization Agreement.

LabCorp – HIE Provider Authorization Agreement

Please note:

• You must initial “Report of Record” option
• Your LabCorp Account Number must be included
• Send the agreement to Karen Bishop via email (kbishop@ohiponline.org)
• CliniSync will validate the data is flowing into the Community Health Record.

3. If you partner with Quest, please click the following link to download a copy of the Quest – CliniSync HIE Add Request Form

Quest – CliniSync Add Request Form

• Please include your practice name and provider details
• Your Quest Account Number must be included
• Send the form to Karen Bishop (kbishop@ohiponline.org) via email
• CliniSync will validate the data is flowing into the Community Health Record

Practice Data Sharing (For members who utilize an Electronic Health Record solution and wish to share information with CliniSync for inclusion into the Community Health Record.)

1. Initiate a ticket with your vendor requesting a project to contribute data to the HIE/CliniSync

• Provide & Register or PnR
• XDS.b / ITI-41
• Provide the HIE/CliniSync contact, Karen Bishop (kbishop@ohiponline.org), additional vendor communications as needed.

2. Once your vendor resource(s) are placed in contact with CliniSync, a kick-off will be scheduled

• Project flow, prerequisites and publishing form will be shared
• We recommend you request specific details from your vendor in regard to tasks and associated costs you may incur to pursue this project

3. Project Decision

4. If you are not currently a signed CliniSync participant, please follow the instructions above for contracting.

Please note:

• Additional Services (contribute) on Pages 6 and 7 must be completed
• If you are a CliniSync participant but did not previously opt for Additional Services, please click on the following link to download a copy of the Participant Agreement Addendum. You’ll select Additional Services (contribute) on Pages 3 and 4.

CliniSync Physician Participant Agreement Addendum

• Once contracting for Additional Services is complete, your vendor may begin sharing project prerequisites with CliniSync.  The project is formalized and submitted for build upon completion of prerequisites.  You will work through the consent process during the build, details will be forthcoming
• Download the CCD/CCDA Document Project Request Form. Work with your current electronic health record (EHR) vendor to complete the form. Your vendor will select and/or define their capabilities: CCD/CCDA Document Project Request Form

View CliniSync Members here

View Types of Data Members are Contributing here

If you have any additional questions or would like more information, please contact your Ohio Health transformation coach via email at practicetransformation@ohiohealth.com. We look forward to working with you!