Accreditation Application

APPLY FOR ACCREDITATION SERVICES

This application is only for Healthcare Institutions that are seeking for Healthcare Accreditation

After submission, We will send you a complete proposal based on the information you have filled out.

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Name & Address

Hospital Name

Write the name of your hospital

Hospital Address

Location of your hospital

Write the Name of Accreditation You Want to Apply

Scope of Services

Services provided (Categories e.g. Emergency, Outpatient,.........)& (Specialties e.g. Surgery, Medicine,.....) , Working days, working hours,........

Scope (copy)

Top Five Diagnosis

List of the most frequent diagnosis admitted to your hospital

Top Five Procedures

List of the most frequent procedures operated in your hospital

Contracted Services

List of any outsources services provided

Number

Number of Hospital Active Beds

Average Number of Daily Occupied Beds

Number (copy)

Average Number of Out Patient Visits / day

Average Number of daily emergency visits

Has your hospital been accredited by any other accreditation organization

Hospital Director Name

First

Last

Email & Check In/Out

Phone Number

Accreditation Coordinator Name

First

Last

Email & Check In/Out (copy)

Phone Number

Additional Information (Optional)

Office Address

Phone Number

Email Address

APPLY FOR ACCREDITATION SERVICES

This application is only for Healthcare Institutions that are seeking for Healthcare Accreditation