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About
About QCIPN
About Queen’s MSSP ACO
Queen’s MSSP ACO Public Transparency
Join
Join QCIPN
Join Queen’s MSSP ACO
FAQs
Resources
Community & Provider Resources
Pediatric Resources
Walk with a Doc
Contact
Login
Compliance Attestation
2023 Practice Signatory Compliance Training Attestation
After all providers participating in the Queen's MSSP ACO contract have viewed the compliance training, the practice signatory should complete this form. Please submit 1 form per practice.
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Name
*
First
Last
Email
*
Practice Name
*
Tax-ID Number
*
I attest that all of the providers at my practice and I have received education and training related to Queen’s MSSP ACO compliance program and have agreed to comply with all of the Queen’s MSSP ACO Compliance Policies and Procedures.
*
Yes
No
Comment or Message
Submit
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