HIway Attestation Forms

Provider Organizations subject to the HIway Connection Requirement must submit annual documentation attesting to their efforts to implement health information exchange use cases.

Starting in 2021, Acute Care Hospitals will also need to submit information regarding participation in the Statewide ENS Framework.

Provider Organizations must submit via online Attestation and Exception Webforms. The HIway provides PDF versions of the forms to enable providers in preparing responses for completing the online attestation, but the HIway will not accept digital/scanned PDF submissions.

For more information, please review the Mass HIway Regulations Summary and FAQs.                  

2021 Deadline

The 2021 attestations start August 2, 2021. The deadline to submit attestations regarding your 2020 use cases and ENS participation is October 31, 2021.

PDF Preparation Forms

PDF versions of the 2021 Attestation and Exception forms are available below. Use these forms to plan your answers ahead of your online submission. Do not submit these forms to the Mass HIway.

Click here for the Year 3 and 4 PDF Attestation Form
(For Small Community Health Centers, Medium/Large Medical Ambulatory Practices, and Large Community Health Centers)

Click here for the Year 5 PDF Attestation Form
(For Acute Care Hospitals)

Click here for the PDF Exception Form
(For provider organizations that did not meet the Connection Requirement in 2020)

Online Attestation and Exception Webforms

Use the online webforms to submit your attestation.

Click here to access the online Attestation and Exception Forms

Unique IDs

Provider Organizations must enter their organization’s unique ID (and, if applicable, the unique IDs for any sub-organizations) on their attestation/exception form. Your ID is assigned by the HIway and can be found using this document with the unique IDs (version 9/16/2021).