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My facility is interested in / applying for accreditation in…
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Sample QI Evaluation Form – Testing and Ablation (Pediatric)
March
18
,
2022
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Certificates Inquiry
Name
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First
Last
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Phone
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Vascular Testing
Echocardiography
Nuclear/PET
MRI
CT / Dental CT
Carotid Stenting
Cardiac Electrophysiology
Cardiovascular Catheterization
Vein Center / Vascular Interventional
Application Number
(Required)
Which applies to you regarding your IAC Certificates:
(Required)
I have not received e-mail invitation to order IAC certificates.
I ordered IAC certificates in the system, but have not yet received them.
I made changes in my IAC online application and need new copies of certificates.
Certificates arrived, but are damaged or there is an error on them.
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Last
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Phone
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For which modality(ies) are you inquiring about?
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Vascular Testing
Echocardiography
Nuclear/PET
MRI
CT / Dental CT
Carotid Stenting
Vascular Interventional/Vein Center
Cardiac Electrophysiology
Cardiovascular Catheterization
Select one or more.
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If you have an existing IAC Online Accreditation Account, please enter your Application or Account number for reference. If not applicable, enter N/A.
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