QI Project Registry: Access Request Form Teaching for Quality at BCM

THIS FORM IS USED TO REQUEST ACCESS TO THE I-QIPS QI PROJECT REGISTRY.

Requests may be submitted by faculty, staff, or trainees associated with a BCM-affiliated institution, who is interested in using the QI Project Registry, but does not have (or is uncertain whether they have) a BCM Enterprise Computing Account (ECA).

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MOC Part 4 Credit - QI Posters:

If you are seeking MOC Part 4 credit consideration through the BCM MOC Program QI Poster submission process and you meet BOTH of the following conditions, then you do NOT need to submit this form (or register your QI Project in the QI Project Registry): 1) You are NOT a BCM-affiliated physician/physician assistant, AND 2) You are NOT affiliated with one of the other ABMS Portfolio Program Sponsor organizations.

Be advised - As an ABMS Portfolio Program Sponsor, Baylor College of Medicine (BCM MOC Program) is NOT permitted to process MOC Part 4 credit requests for QI Posters from a physician/physician assistant who is affiliated with another Program Sponsor organization (link above).

If you are affiliated with one of the other Program Sponsor organizations, please contact that organization directly to inquire about their requirements and process/timeline for MOC Part 4 credit submissions. (With that said, IF your Program Sponsor organization does not have a QI Poster pathway available for earning MOC Part 4 credit, please contact the BCM MOC Program, who may be able to assist.)

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All QI Project Registry access requests submitted through this form are considered and approved on an individual basis. Please allow approximately 2 – 3 business days to receive a response and for your access to the QI Project Registry to be setup if approved. Decision notifications will be sent to the email address provided via this form.

For any questions or assistance, use the Contact Us Form or send an Email.

Note: All members of the Baylor College of Medicine (BCM) community have access to the QI Project Registry by using their BCM Enterprise Computing Account (ECA) credentials to sign in where prompted. If you have a BCM ECA, you do NOT need to submit this form.

Please provide the information requested below. To avoid any delays, please provide a thorough response for each required item.

First Name*

Last Name*

Credentials*

Example: MD, PA-C, PhD, MHA, MBA, etc. (Enter "N/A" if not applicable)

Email*

To avoid any delays, please ensure that you have entered a valid email. Decision notifications will be sent to the email address provided here.

BCM ID*

If you have a BCM ID number, please enter it here. (Enter "N/A" if not applicable)

Are you a current BCM or BCM-affiliated employee?*

Yes

Primary Institution*

Please indicate the BCM-affiliated institution with which you are primarily associated. (If you are not associated with any of the institutions listed, select "Other Institution" and specify your institution where prompted below.)

Primary Institution - Other:*

If you selected "Other Institution" in the previous question, please provide the FULL NAME, CITY, and STATE of your primary institution here. (Otherwise, enter "N/A".)

Department*

Please enter your department name, as associated with the primary institution you indicated above.

Specialty*

(Enter "N/A" if not applicable)

Why are you requesting access to the QI Project Registry?*

Reminder - If you are seeking MOC Part 4 credit for a QI Poster: You do NOT need to complete this form IF you are NOT a BCM-affiliated physician/physician assistant AND IF you are NOT affiliated with one of the other ABMS Program Sponsor organizations.