New IDEAS: PET Facility Site Feasibility Questionnaire General PET Facility Information Question Title * 1. Name of PET Facility Question Title * 2. Type of Facility Hospital-based facility accredited by a Medicare-approved hospital-accrediting body (i.e. Joint Commission, DNV) Not hospital-based (physician office or Independent Diagnostic Testing Facility) Question Title * 3. Is your facility accredited for brain PET? Yes (accredited by American College of Radiology (ACR), Intersocietal Accreditation Commission (IAC), RadSite) No Question Title * 4. Is your facility eligible to bill for Medicare services? Yes No Question Title * 5. Did your facility participate in the original IDEAS Study? Yes No Question Title * 6. How many Brain PET with F-18 fluorodeoxyglucose (FDG) studies did your facility perform during the past 12 months? Less than 25 26 - 50 51 - 75 76 or more Question Title * 7. Physical Address of Facility Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Next