Organization Information
First Name:
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Last Name:
*
Organization Name:
*
Main Facility Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Multiple/Mobile Sites
*
Please Select
None
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20-25
25-30
30+
Phone Number:
*
-
Area Code
Phone Number
E-mail:
*
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Accreditation Applications
IAC Echocardiography (ICAEL) Accreditation:
*
Not Applicable
Adult Transthoracic Echocardiography
Adult Transesophageal Echocardiography
Stress Echocardiography
Pediatric Transthoracic Echocardiography
Pediatric Transesophageal Echocardiography
Fetal Echocardiography
IAC Vascular Testing (ICAVL) Accreditation:
*
Not Applicable
Extracranial Cerebrovascular (Carotid Duplex)
Intracranial Cerebrovascular (TCD)
Peripheral Arterial Ultrasound
Peripheral Venous Ultrasound
Visceral Vascular
Screening Ultrasound- CAMS Accreditation
ACR Accreditation:
*
Not Applicable
OB Antepartum Ultrasound
OB Trimester Specific Ultrasound
Gynecologic Ultrasound
Breast Ultrasound
General Ultrasound
Vascular Ultrasound
AIUM Accreditation:
*
Not Applicable
Abdominal/General Ultrasound
Breast Ultrasound (Diag/Interv)
Thyroid/Parathyroid Ultrasound
Musculoskeletal Ultrasound
Fetal Echocardiography
Gynecologic Ultrasound
Obstetric (Trimester Specific)
Type of Service:
*
Comprehensive
Telephone Support
Final Application Review
Timeline for Application Submission:
*
1 month
3 months
6 months
9 months
12 months
N/A - Quality Assurance Only
Currently Accredited:
*
Yes
No
Renewal Date:
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Staff & Equipment Information
Interpreting Physicians:
*
Please Select
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20
20-25
25-30
30+
Sonographers:
*
Please Select
None - Physicians Only
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20-25
25-30
30+
Are your sonographers registered in the applicable accreditation category(ies)?
*
Yes, all are registered.
Some are registered.
No, none are registered.
N/A - Physicians Only
Age of US Equipment (Years)
Please Select
1
2
3
4
5
6
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9
10
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14
15
Digital Aquisition:
*
Yes
No
Unsure
Do you use a structured reporting system?
*
Yes
No
Unsure
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Accreditation Service Information (Optional)
How did you hear about TAC's Accreditation Services:
Colleague Referral
Direct Mail Marketing
Ultrasound/Echo Event
Google Search
Bing Search
Other Internet Search
Other
Reason for seeking help from a consulting firm (check all that apply):
Overwhelmed by the accreditation process
Too much paperwork
Not enough staff, need to focus on patient care
Not enough time to complete the process
Unsure what is required by IAC/ACR/AIUM
Not sure where to start
Want to ensure accreditation is passed
Reason for Seeking Lab Accreditation:
Current Insurance Mandate
Upcoming Insurance Mandates
Prestigious Lab Status
Unsure
Expected Price Range for TAC Accreditation Services:
$1000-$2500
$2600-$4000
$4100-$6500
$6600-$8500
$8600-$10000
$10500-$13000
$13500-$15000
$15500+
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