Electronic Application (E-App) Checklist for Hospital ...

Electronic Application (E-App) Checklist for Hospital Accreditation

The E-App Checklist is designed to help you organize your information. Before you begin filling out the Electronic Application for Accreditation (E-App), we encourage you to gather information as indicated in the following checklist.

? For Initial Customer (never been through a JCI survey) - The first time navigating through the E-App requires you to complete the pages/tabs in sequential order (Guided Navigation). - It is important to note that this is only required for the first submission. - For the subsequent submissions, you will be able to move freely throughout the application and make appropriate updates.

? On the right-hand side of the screen as you complete the E-App there are various resources available to help you with completion of the E-App, such as Frequently Asked Questions (FAQs), helpful hints, and an improved glossary.

Now you are ready to start gathering your E-App data!

Tab 1: Organization Organizational Chart- Upload your most recent Organizational Chart Financial information: - For billing purposes provide (if applicable): o Tax ID o PO/other ID

Tab 2: Programs This tab is where your organization will tell us which program(s) you'll be applying for accreditation.

Initial Customers (organizations that have never surveyed): Select all the program(s) you are applying for accreditation

Triennial Customers (have been through at least one survey). Only unselect a program if it's your organization intent to withdraw the program from accreditation. Organization with more than one program and with different expiration dates are required to update the entire application. We will only schedule the program that is due for survey. Below is information/data you will be asked to provide in Tab 2: Non-clinical services - Services that support the delivery of patient care. For example, human resources, housekeeping, dietary, information technology, finance, security, etc. Contracted services - Services provided by another person, agency or organization outside of your International Health Care Organization Number of medical, dental, undergraduate, postgraduate, nursing, and allied health students List research and clinical trials involving patients currently occurring (if applicable) International Library of Measures voluntary participation ? select measure if you agree to participate

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Tab 3: Regulations/Licenses All applicable copies of each permit or license. If the license is not in English, please upload a copy of the translated license as well. The application cannot be accepted until all documentation is received.

Tab 4: Sites/Services Note: List of all sites ? each individual building should be listed as a separate site (please refer to site map below)

Site details All sites and locations where clinical services are provided Building and Fire Safety code requirements Age of building in years Area of building in square meters

Inpatient Information: Volume (be prepared with one year of inpatient volume data) Total number of inpatient beds Total number of "licensed" inpatient beds The average number of inpatient beds that are occupied daily Total number of "non-emergency" holding beds o Emergency Department Total number of emergency department beds Total number of "emergency" holding beds (located within emergency department or another designated location in the organization) Total emergency department visits per year o Total number of beds dedicated to the "observation" of patients who are not admitted to inpatient beds

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Tab 4 (Sites/Services) continued: o Inpatient Units/Wards (list each care patient unit/ward separately) Name of Unit/Ward Average number of beds occupied Type of care given

Inpatient Operating theatres (List the type of theatre and number of individual surgical rooms in each theatre) Inpatient Clinical Services (Check all applicable Clinical Medical Services or Units currently provided by the organization)

Outpatient Information: Volume (be prepared with one year of outpatient volume data) Total number of outpatient visits for last full year Total number of outpatient beds dedicated to the observation of outpatients Total number of outpatient surgical procedures for the last full year

Outpatient Clinics (List all outpatient clinics at your organization; include number of annual visits at each clinic)

Day Surgery/ Outpatient Operating theatres (List any operating room theatres used for day surgeries if they are not already list in the "Inpatient Operating Theater" section.

Outpatient Clinical Services (Check all applicable Outpatient Clinical Medical Services currently provided by the organization)

Top 5 Discharge Diagnosis for your entire organization.

Top 5 Surgical Procedures for your entire organization

Medical transport--number of patients transported per year Home care--number of visits per week and total per year Potential changes in the next 12 months

Tab 5: Scheduling Five weeks of preferred survey dates in order of preference Entry forms for surveyors, if required Preferred accommodations Preferred airport Ground transport instructions ? Directions/map from airport to accommodation ? Directions/map from accommodation to organization

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