CHI Forms
Applicants subject to CHI requirement are expected to contact the Department at DONCHI@State.MA.US at least two months prior to the planned filing of the DoN Application in order to determine which forms will be required at the time of Application.
Additional Resources for
Open PDF file, 769.52 KB, for
Stakeholder assessment
(English, PDF 769.52 KB)
Open PDF file, 1.32 MB, for
CHNA/CHIP Self-Assessment
(English, PDF 1.32 MB)
Open PDF file, 779.1 KB, for
Community Engagement Plan
(English, PDF 779.1 KB)
Open PDF file, 458.08 KB, for
Community Engagement Guidelines for Community Health Planning - PDF
(English, PDF 458.08 KB)
Open PDF file, 382.12 KB, for
Community Health Initiative Planning
(English, PDF 382.12 KB)
Open DOCX file, 1.07 MB, for
Community Health Initiative Planning
(English, DOCX 1.07 MB)
Open PDF file, 786.78 KB, for
Health Priority
(English, PDF 786.78 KB)
Open DOCX file, 1.12 MB, for
Health Priority
(English, DOCX 1.12 MB)