Prior to completing this form, accredited facilities wanting to change a radiology group MUST:
- Enter the information for the new interpreting physician(s) as a Medical Director or Medical Staff member(s) in the Manage Staff section of your facility’s current Online Accreditation application including the specific training and experience pathway for each physician. (Refer to the IAC Standards >> Section 1A: Personnel and Supervision for Guidance)
- Mark the prior Medical Director or Medical Staff member(s) who are no longer performing interpretations at this facility as deactivated.
Once the items above are completed, proceed with completing the following form. Once the form is received, you will be contacted by an IAC staff member with instructions on uploading the required documentation:
- A formal letter of notification from a person listed on the Accreditation Agreement or the Technical Director to confirm the change of radiology group.
- Documentation for each new physician (Medical Director, medical staff member[s]) to support the selected training and experience pathway as outlined in the Standards (e.g., current state medical practitioner license, verification of interpretation training, etc.).
- Three case studies representing as many different new physicians and testing areas (as possible).
- The final report and a Scan Parameter Form.
- If this change of radiology group is also a change of the ownership of this facility, please update the Agreement your Online Accreditation application.