Background and Significance: Refugees arriving in the US face significant and unique health challenges. All refugee children should be seen by a clinician for a Domestic Medical Exam (DME). To aid clinicians with this DME, the CDC has developed guidelines for care and screenings. A consortium of refugee healthcare providers across multiple institutions analyzed these guidelines to inform the development of clinical decision support (CDS) to standardize care for newly arrived refugees. Particular attention was paid to the shifting needs of children as guideline recommendations were based upon age and gender. This CDS was developed at a pilot institution with a plan for dissemination. Objectives: Develop and test a process for transitioning evidence-based CDS for refugee health to external institutions. Methods: Prior to the pilot, we conducted a self-assessment workflow analysis at multiple institutions. We developed CDS using commonly available EHR functionality. We developed artifacts to support subsequent institutions during implementation. We provided guidance and support for implementation at a second institution. We conducted post-implementation discussions to collect data on the installation, address residual barriers, and identify ways to streamline sharing. Results: We identified two refugee care workflows that needed to be supported by the CDS. Differences between these workflows required small alterations to the implementation plan. Guidance was developed to help institutions determine which workflow best matched the institution’s current state. Sharing of the CDS was carried out through two channels. We exported raw CDS components from our EHR into the vendor’s user site. We also developed a build document and testing script, which were provided to the second institution. The build document provided instructions for recreating the CDS module (2 order sets and 1 documentation template). After implementation at the second site, we noted the documentation templates included only small differences to align with institutional requirements but were sufficiently similar to support data aggregation across institutions (Figure 1). Each order set contained customization points for 12 combinations of age and gender. There were 9 versions of the documentation template again supporting differences for age and gender. Migration of the first order set and the documentation template required 20 analyst hours. Key issues identified during post-implementation discussions included aligning with organization requirements and developing links to external resources. Lessons learned were incorporated into the build documentation for subsequent institutions, including clearly identifying customization points in the build document (Figure 2) and the development of an implementation readiness checklist. Conclusion: Structured sharing of CDS between institutions using the same vendor is possible and can be used to standardize healthcare delivery and documentation across institutions. Identification of implementation issues at a second site allowed for the detection of implementation barriers prior to the planned multi site roll out.