CMS/MIPPA Questionnaire

We look forward to hearing from you.

CMS/MIPPA
Name *
First Last
Email *
Phone
### - ### - ####
What is the name of your facility? *
Is your facility already accredited by one of the three accreditation organizations? If so which one? *
 No 
 The American College of Radiology 
 Intersocietal Accreditation Commission 
 The Joint Commission 
Have you begun or are you currently in the accreditation application process? *
 Yes-Please explain below 
 No 
If yes please explain below?
Has your facility recently been declined accreditation? *
 Yes 
 No 
Are you looking for a teleradiology solution? *
 Yes 
 No 
If yes please provide a few details of what you are in need of.
Is your facility in need of a Supervising Physician/Medical Director? *
 Yes 
 No 
What is your expected time frame to initiate your application? *
If you have not started the application process which accredited organization are you considering or have you considered? *
 The American College of Radiology 
 Intersocietal Accreditation Commission 
 The Joint Commission 
 Undecided 
 N/A 
Please provide any other pertinent information that will be helpful in getting you the information you need.