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LTSS - Maryland Department of Information Technology

LTSS - Maryland Department of Information Technology 2026

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The document is an addendum to the HIE Participation Agreement between Chesapeake Regional Information System For Our Patients (CRISP) and a facility providing substance use disorder services. It establishes CRISP as a Qualified Services Organization, allowing access to protected patient information under 42 C.F.R. Part 2 for the purpose of delivering specific services while ensuring compliance with confidentiality regulations. The addendum outlines definitions, services to be performed, compliance obligations, and termination conditions.

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Click ‘Get Form’ to open the LTSS document in the editor.
Begin by filling in the name of your organization in the designated field. Ensure that this matches your official registration.
In the section regarding services, provide detailed information about the Part 2 Information you will share with CRISP. This includes demographic panels of current patients.
Review the compliance section carefully. Confirm that you understand and agree to adhere to all provisions outlined under 42 C.F.R. Part 2.
Complete the signature fields at the end of the document, ensuring that both parties sign and date appropriately to validate the agreement.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (113 Votes)
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2019	4.2 Satisfied (58 Votes)
2018	4.8 Satisfied (111 Votes)
2017	4.5 Satisfied (25 Votes)
2017	4.7 Satisfied (37 Votes)
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2006	4 Satisfied (30 Votes)

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LTSS - Maryland Department of Information Technology 2026

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