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.
- Protocol for Performing Complete Pediatric Transthoracic Echocardiograms (51KB)
- Sample Fetal Protocol (252KB)
- Sample Pediatric TEE Protocol (53KB)
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 Meeting Minutes (58KB)
- Pediatric QI Correlation of Documentation Worksheet (60KB)
- Patient Complaint Policy (27KB)
- Patient Confidentiality Policy (53KB)
- Primary Source Verification Policy (39KB)
- Ergonomics Sample Policy (92KB)
- Preliminary vs. Final Report Policy (51KB)
- Radiation Safety Policy (40KB)
- 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 (807KB) (Updated 6-15-2021)
- Evaluating Fetal Studies and Reports Checklist (68KB)
- Evaluating Pediatric TTE Cases and Reports Checklist (58KB)
- Evaluating Pediatric TEE Study Report Checklist (67KB)