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.

Hospital Name *

Write the name of your hospital

Hospital Adress *

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,........

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 of Hospital Active Beds *

Average Number of Daily Occupied Beds *

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 *

Phone *

Accreditation Coordinator Name *

First

Last

Email *

Phone *

Additional Information (Optional)