Certification 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. X-Ray License*:

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

3. X-Ray Attestation & Photo*:

• Attest to possessing X-Ray equipment that can perform:
  • Chest x-ray
  • C-spine
  • Long bone films
  • Abdomen
  • Extremities
• Photo of facility’s X-Ray equipment on site (Fixed or Portable)

4. Laboratory License*:

• 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)