Certification Criteria


CUC Required Criteria

1. Copy of business license for this facility, certificate of occupancy or equivalent

2. Exterior photo clearly showing entire facility structure and external signage

3. Photo of main entry door or sign indicating days and hours of operation to the public

o   If facility does not meet criteria 3, provide address of nearest owned center that meets special circumstances criteria (center must be certified or have an application in process)

o   If photo does not include advertisement that walk-ins are accepted during all hours, provide separate proof of advertisement

4. Copy of current of one of the following x-ray documents:

o   Inspection certificate

o  State registration

o   Licensure

5. Copy of current laboratory licensure

6. Organizational chart including names of all current facility staff and providers with credentials (“MD”, “DO”, “NP”, etc.)

7. Copy of facility floor plan with clear labels marking EACH of the following items: exam rooms, treatment rooms (if separate), patient restrooms, x-ray, laboratory, portable defibrillator, oxygen and drug cart

8. Photos of portable defibrillator, oxygen equipment and drug cart and facility’s radiological equipment on site (Fixed or Portable)

9. List of all medications and equipment contained in drug cart – should include adult as well as pediatric

10. Copy of recent advertisement, flyer or similar marketing piece for this facility (billboard photos accepted)

11. Description of role of Medical Director for this facility

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

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




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