Chronicle Diabetes

Change of Quality Coordinator Form

This form is for requesting a change of Quality Coordinator for your program. You will need to enter the email address of the current Quality Coordinator, the email of the new Quality Coordinator, the date you want this change to take place and the six digit Program ID.
Please Note: This form is for Quality Coordinator Changes only. The changes below can be made through the ERP Portal by the Quality Coordinator or Assistant Coordinator:
  • Quality Coordinator last name or email address change only
  • Site Name
  • Organization Name
  • Address
  • Phone Number
  • Fax Number
If there has been a substantive change in the program such as a site closing, site moving to another sponsor or changes in sponsor relationship please email ERP@diabetes.org and include your program ID# in the message. (Depending on the change, you may be sent an Interim Status Report which will allow you to provide additional details about the program change.)
* indicates a required field.
Email Address of Current Quality Coordinator*:


What should be done with the previous Quality Coordinator account*:


Program ID* (Please include all 6 digits of your service ID#):


Effective Date*:




Email Address of New Quality Coordinator*:


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