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- Click ‘Get Form’ to open the cdph8623 2007 form in the editor.
- Begin with SECTION 1—FACILITY STATUS. Select the appropriate category for your application by checking one of the boxes and circling your specific selection.
- In SECTION 2—FACILITY ADDRESS INFORMATION, fill in all required fields including facility name, contact information, and addresses. Ensure accuracy to avoid processing delays.
- Move to SECTION 3—FACILITY MAMMOGRAPHY ACCREDITATION HISTORY. Answer the questions regarding previous applications and accreditation status, providing detailed explanations if necessary.
- Complete SECTION 4—FACILITY PROCEDURE INFORMATION by indicating the number of procedures performed annually and whether you accept self-referrals.
- In SECTION 6—PERSONNEL QUALIFICATIONS, list all relevant personnel along with their qualifications. Use additional sheets if needed for comprehensive details.
- Finally, review all sections for completeness before signing in SECTION 9—ACKNOWLEDGMENT AND CERTIFICATION. Ensure that all declarations are accurate and truthful.
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