Sample Documents (Pediatric Echocardiography)
The IAC is pleased to include sample documents to assist facilities in providing quality care to their patients. These documents meet or exceed the requirements of the Standards, and they may be used to develop facility policies and reporting forms, whether your facility is seeking accreditation or simply working to standardize or improve current practices.
Please note: The following documents are SAMPLES only. Protocols submitted with the application must be customized to reflect current practices of the facility.
Quality Improvement Documents
- IAC Quality Improvement (QI) Self-Assessment Tool
The IAC QI Self-Assessment Tool is a free feature, created to help your facility document and analyze continuous process improvement and meet the quality measures required by the IAC diagnostic imaging accreditation programs (Vascular Testing, Echocardiography, Nuclear/PET, MRI and CT).
- Sample QI Policy (Pediatric Echocardiography) (56KB
- Sample QI Evaluation Forms (Use of these evaluation forms will meet all the required IAC Echocardiography Quality Improvement Standards effective February 3rd, 2016.)
- Sample QI Meeting Minutes (58KB)
- Pediatric Correlation Documentation Form (64KB)
- Patient Complaint Policy (27KB)
- Patient Confidentiality Policy (53KB)
- Primary Source Verification Policy (39KB)
- Ergonomics Sample Policy (92KB)
- Preliminary Policy (28KB)
- Preliminary vs. Final Report Policy (51KB)
- Correlation Policy (53KB)
- CME Policy (44KB)
- Radiation Safety Policy (40KB)
- IAC Echocardiography Accreditation Checklist (876KB) (Updated 6-8-2016)
- Evaluating Fetal Studies and Reports Checklist (57KB)
- Evaluating Pediatric TTE Cases and Reports Checklist (58KB)