Organization Profile Form - RMA
Organization Profile
Organization Name
*
School Type
*
High School
Community College
Career School
Technical
University
Apprenticeship
Workforce Development
High School Affiliate
*
Name of Partnered Organization
Program is:
*
Registered with the US Department of Labor (DOL)
A federally recognized State Apprenticeship Agency (SAA)
Other
Workforce Development Affiliate
*
Name of Partnered Organization
Campus Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Title
*
Business Email
*
example@example.com
Phone Number
*
Website Address and/or Academic Program Links
*
example: www.amt-university.org
Accreditor (check all that apply)
*
ABHES
ACCET
ACCSC
ACICS
CAAHEP
Other
Current Certification Agency Used (check all that apply)
*
AMT
AAMA
NHA
NCCT
None
Other
Program Curriculum
Number of Classroom Clock Hours (as indicated in catalog)
*
(Convert credit hours to clock hours)
Number of Externship Clock Hours
*
(Convert credit hours to clock hours)
Minimum Program Requirements
Check all areas below which apply to your curriculum
Anatomy and Physiology
Body Systems
Medical Terminology
Administrative Medical Assisting
Insurance
Financial Bookkeeping
Medical Receptionist / Secretarial / Clerical
Medical Laws and Ethics
Human Relations
Clinical Medical Assisting
Asepsis
Sterilization
Instruments
Medical Laws and Ethics
Human Relations
Clinical Patient Interaction
Patient Education
Vital Signs and Measurements
Physical Examinations
Clinical Pharmacology
Therapeutic Modalities
Laboratory Procedures
Electrocardiography (ECG)
First Aid, CPR, and Emergency Response
N/A
(If other)
N/A
(if other)
N/A
Anatomy and physiology
Medical law and ethics
Medical terminology
Psychology/human relations (or equivalent)
N/A
Basic clerical functions to include: reception, ordering, office safety, etc.
Manual and computerized records management
Financial management and bookkeeping
Insurance (including procedural and diagnostic coding)
N/A
Asepsis/Sterilization/Infection control
First aid CPR
Patient examination and preparation (vital signs, physical exam, patient history, etc.)
Specimen collection and phlebotomy
Pharmacology
Injection
Basic laboratory procedures
Total Program Requirements Selected
Agreement
*
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