Mammography certification form 2026

1. Click ‘Get Form’ to open the mammography certification form in the editor.
2. Begin with Section 1, where you will indicate the type of facility and reason for submission. Check the appropriate boxes and provide your State Registration Number.
3. In Section 2, fill out your facility information including name, contact details, and addresses. Ensure all fields are completed accurately for effective communication.
4. Proceed to Section 3 to disclose any previous accreditation history. If applicable, provide detailed explanations for any denials or suspensions.
5. Complete Section 4 by entering the number of procedures performed at your facility. This includes screening, diagnostic, and therapeutic procedures.
6. In Section 6, list all personnel qualifications including physicians and technologists. Attach additional sheets if necessary to document their credentials.
7. Fill out Section 7 regarding mammography equipment information. Include details about each machine used in your facility.
8. Finally, review Sections 8 and 9 for acknowledgment and certification before signing off on the application.

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