Electronic Confirmation of Participation (eCOP) Form

The electronic Confirmation of Participation form can be used to enroll providers in CII/CPAR.  The form is usually completed by the Site Liaison and is submitted to AMA-ACTT and eHealth Support Services. Once processed, the Site Liaison will receive an email from eHealth Support Services with next steps.

Saving and Submitting Forms

When the contact information page of the electronic form is completed, the user will receive a link to the form at the email address provided. The form is saved with each “Next” click and the provided link can be used to resume editing if the form is not completed in one sitting. You can also forward the link to others to provide input on the form, if needed.  You will receive an email confirmation upon form submission. 

Submitting Clinic Changes

Save the link that was emailed in order to access the completed form in the future. This will allow you to reopen the form, edit it, and resubmit it if any changes to CII/CPAR participation occur at the clinic. For example, you could access the completed form in the future in order to add a new provider that is joining the clinic.

PDF version of CoPs are still being accepted. Click the link below to access the PDF versions and instructions for how to use them.