Dear Radiation Oncology Services Providers:

The Veterans Access, Choice and Accountability Act (VACAA) directed the establishment of the Veterans Choice Program (VCP) to better meet the health care needs of our Nation's Veterans. The law directs the establishment of a Veterans Choice Card benefit that provides a commitment to Veterans to receive healthcare in their communities if they live more than 40 miles away from a Veterans Health Administration (VHA) medical care facility. The Choice Program requires that all community-based providers must meet the VHA certification standards and must agree with the program requirements prior to rendering services to the Veterans. The National Radiation Oncology Program (NROP) of VHA has established some basic requirements for both in-house and contracted radiation oncology services to ensure quality care for our Veterans. These requirements include; practice accreditation, board-certified radiation oncologist and therapeutic medical physicist, facility credentialing for advanced radiotherapy procedures (e.g. IMRT, SRS, SBRT, and IGRT), prospective peer review, and electronic documentation of radiation treatment into CPRS (VHA Electronic Medical Record System).
 
Please respond to the following questions in this request for information about your practice.
 
If you have additional questions, please contact Ms. Wendy Kemp at the NROP office (Wendy.Kemp@va.gov)
National Radiation Oncology Program (10P11H)
Veterans Health Administration
Building 507, Room A-105
1201 Broad Rock Blvd.
Richmond, VA  23249

Thank you.
 
Please fill in your facility's information below and submit.

Question Title

* 1. Reason for submission

Question Title

* 2. Contact Information

Question Title

* 3. Other facility names and/or addresses used for current facility in the past or present?

Question Title

* 4. Is your facility currently accredited by ACR / ACRO / APEX?

Question Title

* 5. If no, when does your facility intend to apply for ACR/ACRO/APEX accreditation in the future?

Question Title

* 6. Number of full time Radiation Oncologist(s) on site?

Question Title

* 7. Number of Board Certified Radiation Oncologist(s) on site?

Question Title

* 8. Number of full time Therapeutic Medical Physicist(s) on site?

Question Title

* 9. Number of Board Certified Therapeutic Medical Physicist(s) on site?

Question Title

* 10. Number of treatment platforms (e.g. Linacs, Tomotherapy, Cyberknife, Gammaknife)?

Question Title

* 11. Number of RTTs present for patient treatment / treatment platform?

Question Title

* 12. Services offered at the facility

Question Title

* 13. Is radiation oncologist present at the linac during the delivery of every SBRT and SRS treatment?

Question Title

* 14. Is medical physicist present at the linac during the delivery of every SBRT and SRS treatment?

Question Title

* 15. Do you subscribe to independent remote output check of your Linac/s (e.g. TLDs or OSLDs)? 

Question Title

* 16. If yes, please specify the last independent remote output check date.

Date

Question Title

* 17. Are you currently credentialed by IROC - Houston for the following advanced procedures?

Question Title

* 18. If you are not credentialed by IROC-Houston for the above advanced procedures, please describe your end-to-end testing procedure.

Question Title

* 19. Do you treat according to ASTRO/ACR treatment guidelines for palliative care?

Question Title

* 20. Which treatment guidelines do you use in your clinic?

Question Title

* 21. Which appropriate use criteria do you use in your clinic?

Question Title

* 22. Please specify the make & model # of the Treatment Delivery Systems used at your facility.

Question Title

* 23. Please specify the make and version # of the Treatment Planning Systems used at your facility.

Question Title

* 24. Name, Email address & Phone Number:

Question Title

* 25. Signature

Question Title

* 26. Signature Date

Date

T