Call Us: 866.966.9030 or Local: 907-770-2626

Participation Agreements

A Participant is defined as an organization or entity utilizing HIE and/or DSM services for purposes of secure, encrypted exchange of Protect Health Information (PHI).

Participation Agreement – Instructions for Use

The above document provides instructions for executing an Alaska eHealth Network Participation Agreement between your organization and AeHN for any of the following services: Health Information Exchange (HIE) and Direct Secure Messaging (DSM).

Participation Agreement
HIE DSM Addendum
DIRECT (DSM) HCO Account Request Form
Declaration of Identity (DoID) Form

I. STEP ONE: Review and sign the Participation Agreement. This is the base document for participation in all Alaska eHealth Network (AeHN) activities and is required to participate in any of the AeHN programs. Participant must check the type of Addenda which will be included in the Participation Agreement on Page 6 below the signature. Note: A Participant is defined as an organization or entity, not as a specific individual. Only an authorized signatory may sign the Agreement on behalf of the organization.

II. STEP TWO: Choose the programs in which your organization would like to participate at this time. Participants may enroll in as many programs as they would like, so long as they meet any applicable qualifications. The choice of programs does not limit any future options – a Participant may add programs at any time, and may disenroll from programs in accordance with the termination provisions of the Participant Agreement.

III. STEP THREE: Review and sign the applicable Addendum for each chosen program as follows:

HIE Participation (automatically includes DSM use) – Review and execute the HIE DSM Addendum. Review and fill out the DIRECT (DSM) HCO Account Request (HCO) Form and Declaration of Identity (DoID) Form.  Click here for instructions on HCO and DoID forms.  The Participation Agreement and the HIE/DSM Addendum are the applicable terms and agreements for your participation in the HIE.  The DIRECT (DSM) HCO Account Request Form and Declaration of Identity (DoID) Forms are required for DIRECT/DSM certification.

DSM Only – Review and execute the HIE DSM Addendum. Review and fill out the DIRECT (DSM) HCO Account Request Form and Declaration of Identity (DoID) Form.  Click here for instructions on HCO and DoID forms.  The Participation Agreement and the HIE/DSM Addendum are the applicable terms and agreements for your participation in DIRECT/DSM. The DIRECT (DSM) HCO Account Request Form and Declaration of Identity (DoID) Forms are required for DIRECT/DSM certification.

HIE Participation (includes DSM) – Review and execute the HIE DSM Addendum Review and fill out the DIRECT(DSM) HCO Account Request (HCO) Form and Declaration of Identity (DoID) Form.  Click here for instructions on HCO and DoID forms.  The Participation Agreement, HIE/DSM Addendum are the applicable terms and agreements for your participation in the HIE. The DIRECT (DSM) HCO Account Request Form and Declaration of Identity (DoID) Forms are required for DIRECT/DSM certification.

DSM Participation – Review and execute the HIE DSM Addendum Review and fill out the DIRECT (DSM) HCO Account Request (HCO) Form and Declaration of Identity (DoID) Form.  Click here for instructions on HCO and DoID forms.  

IV. STEP FOUR: Scan, fax or mail the executed documents to AeHN at:

support@ak-ehealth.org, FAX: 1-866-966-9030, Alternate FAX: 1-907-770-1413
Mail: 4000 Old Seward, Suite 203, Anchorage, Ak 99503

For questions:  866-966-9030, x1