Application Technical Contact:
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).
Internal Review Status: complete or incomplete
|Internal Distribution Request Date||Compliance & Regulatory Review||IT Security Review|
Upload collateral as it is collected.
Upload approval artifacts as they are collected.
- Compliance and Regulatory Review.
- IT Security Review.
- Distribution Review Checklist.