Certification Criteria


CUC Required Criteria

1. Validation of Business Entity*:

  • Current copy of one of the following state documents:
  • Business/Occupational License
  • Certificate of Occupancy
  • Certificate of Good Standing/Status/Existence

2. Radiological Equipment*:

  • Current copy of one of the following state radiology room/equipment documents:
  • Inspection certificate
  • Registration
  • Licensure

3. Radiological Equipment Attestation:

  • Attest to possessing radiological equipment that can perform:
  • Chest x-ray
  • C-spine
  • Long bone films
  • Abdomen
  • Extremities

4. Laboratory Licensure*:

  • Current copy of CLIA certificate
  • Current copy of state laboratory certificate, if applicable

5. EKG Requirement Attestation:

  • Attest to the ability to obtain and read an EKG on site

6. Center Organizational Chart*:

  • Organizational chart; management structure

7. Facility Floor Plan*:

  • Copy of facility floor plan with clear labels marking EACH of the following items: exam rooms, treatment rooms (if separate), patient restrooms, radiology room (or storage location of portable equipment), laboratory, AED/portable defibrillator, storage of portable oxygen tanks and location of emergency equipment/supplies (e.g. epi pens, oral airways, etc.)

8. Emergency Equipment/Supplies/Medications*:

  • List of all items stocked for adult and pediatric populations

9. Marketing Materials*:

  • If the center does not have website, attach a copy of recent advertisement, flyer or similar marketing piece for this facility (billboard photos accepted)

10. Medical Director (or equivalent) Job Description Attestation:

  • Attest to written job description available

11. Medical Director Unrestricted Licensure*:

  • Copy of active, unrestricted license for center’s Medical Director

12. Photo Submissions: Facility Structure & External Signage*:

  • Exterior photo clearly showing entire facility structure and external signage
  • Photo of main entry door or sign indicating days and hours of operation to the public
  • If photo does not include advertisement that walk-ins are accepted during all hours, provide separate proof of advertisement circumstances criteria
  • If facility does not meet above criteria, provide address of nearest owned center that meets special circumstances criteria (center must be certified or have an application in process)

13. Radiology Equipment*:

  • Photo of facility’s radiological equipment on site (Fixed or Portable)

RURAL CENTERS ONLY - Attach verification of rural address through use of this link.

*In Certification Bank, only one document can be submitted per checklist item. Please combine multiple documents into one and attach if applicable. Accepted file types: .doc, .docx, .pdf, .jpeg, .png, .xls, .xlsx




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