Global Healthcare Accreditation Application (2018)

Application for Global Healthcare Accreditation - Page 1

Instructions & Important Notes:

Please complete each question as it relates to the management of medical travel, medical tourist and/or international patients and the overall experience at your facility. Please complete as accurately and as timely as possible. Should you have any questions, please contact Mr. Bill Cook at wcook@ghaccreditation.com.
Upon review of your application, a formal recommendation will be made as to move forward with a GHA Survey or schedule a 1-2 day Internal Training Program prior to a GHA Survey.

GHA applies to organizational programs often labeled as Global Patient Services, International Patient Services, Medical Tourism, Dental Tourism, Wellness travel, Medical Destinations Program or Medical Travel Services.

Question Title

* 1. Please enter the information for the individual responsible for the organization's Accreditation Process:

Primary Contact Name: *

Name of Organization *

Primary Contact Email Address: *

Primary Contact Phone Number

Address 1: *

Address 2:

City/Town:

State/Province: *

ZIP/Postal Code: *

Country: *

Question Title

* 2. Please enter the following information:

Main Website Address:

Website or Page Address for Medical Travel, Medical Tourism or International Services:

Question Title

* 3. Please provide your organization's definition and scope of the global/international or medical travel services for which you are seeking accreditation.

Question Title

* 4. Are your organization's policies and procedures stored electronically for employees to access?

Yes

I Don't Know

Question Title

* 5. Please list the top three languages spoken among your staff.

Language 1

Language 2

Language 3

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* 6. Please list the top three languages spoken by the majority of your patients cared for in the services described above in Question 3.

Language 1

Language 2

Language 3

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* 7. Overall Organizational & Operational Structure

Single Facility

Multiple Facilities (System)

Multiple Facilities (Network)

Academic Medical Center

Other

Other (please explain)

Question Title

* 8. Overall Operational Structure for the Medical Travel Program

Single Department

Primary Department with Secondary (Satellite) Departments

Multiple Departments (working independently)

Other

Other (please explain)

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* 9. Please list the names of the following Executive Management positions for your organization.

Chief Executive Officer

Chief Medical Officer

Chief Nursing Officer

Chief Financial Officer

Chief Operations Officer

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* 10. What Clinical Services Support the Medical Travel Program?

Adult ICU

Allergy/Immunology

Anesthesiology

Emergency

Cardiology

Dental Services

Dermatology

Diagnostic Radiology

ENT

Endocrinology

Family Medicine

Gastroenterology

Geriatrics

Hematology/Oncology

Hepatology

Infection Diseases

Internal Medicine

Nutrition and Dietetics

Reproductive Health

Occupational Therapy

Oncology

Orthopaedics

Ophthalmology

Other specialty ICU services

Nephrology

Neurology

Neonatal ICU

OB/GYN

Pathology

Pediatrics

Pediatric ICU

Pharmacy

Physical Rehabilitation

Psychiatry

Pulmonology/Pneumology

Radiation Oncology

Radiology

Rheumatology

Urology

Other (please specify)

Question Title

* 11. Please indicate which clinical services are prioritized within the business strategy of your Medical Travel Program?

Question Title

* 12. Please indicate which business lines apply to your Medical Travel Program.

Clinical Services (Traditional)

Clinical Services (Telehealth)

Dental Services

Direct Contracting (Self-insured Employers)

Concierge Medicine

Business Consulting Services

Outsourced Management Services

Brand Affiliation Services

Other Business Lines (ex.

Other (please specify)

Question Title

* 13. Questions for Facilities with Inpatient Services offered.

Number of Total Licensed Beds

Number of Total Operating Beds

Average Length of Stay (ALOS) for the Past 2 Years (entire inpatient volume)

Average Number of Medical Travel Patients Per Month for the Past Year

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* 14. Questions for Facilities with Outpatient Services offered.

Average Number of Medical Travel Outpatients Visits for Per Month for Past Year.

Number of Outpatient Services Offered to Medical Travel patients.

Question Title

* 15. Are any services offered to medical travel patients outsourced or contracted via third parties?

Yes

If Yes, please describe which services.