Below is a list of documentation that must be completed for the Outpatient Oral Maxillofacial Re-Survey. Please mail completed documentation to AAAASF at P.O. BOX 9500, Gurnee, IL 60031 or fax to 847-775-1985. You may also scan and email to email@example.com.
- A copy of each physician’s State Medical License
- A copy of each physician’s Board Certificate or letter of admissibility by the physician/surgeon certifying board (ABMS or ABOMS)
- A current copy of the delineation of hospital privileges for each physician (must state the department of Surgical Specialty and list the procedures that may be performed at the hospital)
- Authorization to Release Information form signed by each physician on staff
- Facility Identification Form
- Staff Identification Form
- Facility Director's Attestation Form
- New York OBS Addendum (NEW YORK OBS FACILITIES ONLY)
Once all of the required documentation is received in the AAAASF office, it will be reviewed within 10 business days. You will be contacted if additional paperwork is needed. Otherwise, you will receive a request to submit your facility’s hours of operation and blackout dates so that a survey can be scheduled. An email confirmation will be sent to you once the survey has been arranged.
Please review the Standards and Checklist Manual carefully before submitting the completed documentation to AAAASF.