Sample Documents (Carotid Stenting)
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. Click on the name of the file to download the document.
- IAC Carotid Stenting Accreditation Checklist (836KB) (Updated 5-23-2019)
- Fluoro Quality Assurance Guide (65KB)
- Internal Carotid Artery Stenosis: Accuracy of Subjective Visual Impression for Evaluation with Digital Subtraction Angiography and Contrast-enhanced MR Angiography (354KB)
Case Study Tools
- Carotid Stenting Case Study Worksheet (56KB)
- Outcome Data Analysis Chart Guidance (31KB)
- Outcome Data Analysis Chart (55KB)
- Patient Carotid Stent Procedure Log (Optional Sample) (117KB)
- Procedure Log Guidance (27KB)
- Carotid Stenting Attestation Form (Medical Director) (42KB)
- Carotid Stenting Attestation Form (Technical Director) (42KB)
- Medical Director Attestation for Consultant Use [SAMPLE] (58KB)
*Facilities are required to attach a letter from the facility's Medical Director (on the facility's letterhead) providing the consultants permission to complete the application for accreditation on the facility's behalf.