Sample Documents (Adult 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.
- Administration of Lumason for Contrast Echocardiography (62KB)
- Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography
- Sample Contrast Protocol (40KB)
Quality Improvement Documents
- IAC Quality Improvement (QI) Self-Assessment Tool
Created to help your facility employ and document continuous process improvement, this free tool provides a mechanism for facilities to meet the quality measures required by the Standards.
- Sample QI Policy (Adult Echocardiography) (57KB)
- Sample QI Meeting Minutes (58KB)
- Maintenance Log (14KB)
- CME Log (19KB)
Sample Policies & Final Reports
- Ergonomics Sample Policy (72KB)
- Patient Complaint Policy (27KB)
- Patient Confidentiality Policy (61KB)
- Preliminary Policy (24KB)
- Preliminary vs. Final Report Policy (28KB)
- Primary Source Verification Policy (37KB)
- Strain Justification Policy (2.54MB)
- Radiation Safety Policy (40KB)
- Use of Contrast Policy (39KB)
- 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.
- IAC Echocardiography Accreditation Checklist (752KB) (Updated 10-10-18)
- Evaluating ATTE Cases and Reports Checklist (70KB)
- Evaluating ATEE Studies and Reports Checklist (61KB)
- Evaluating Stress Echo Case Report Checklist (53KB)