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AAAASF - Surgical ASC Program

New Applications

Thank you for your interest in the American Association for Accreditation of Ambulatory Surgical Facilities, Inc. (AAAASF).

On this CD you will find the Standards and Checklist booklet and necessary accreditation forms.

Please submit the following documentation along with the completed application either by mail or fax to:

AAAASF

5101 Washington Street, Suite 2F

PO Box 9500

Gurnee, IL 60031

FAX: 847-775-1985

  • Application Form

  • In order to proceed with the processing of your application please submit the following documentation for each physician/surgeon/DDS, using the facility to AAAASF:

    • 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/DDS certifying board (ABMS, AOABOS, ABOMS, or ABPS as applicable).

    • A current copy of the delineation of hospital privileges for each physician/surgeon/DDS (must state the department of Surgical Specialty and list the procedures which may be performed at the hospital).

    • Instructions - Authorization to Release Form

    • Signed Authorization to Release Information form for each physician 

  • The following forms are to be filled out for the Facility.

    • Complete Facility Identification form 

    • Staff Identification Form

    • Facility Director Attestation Form

    • Six completed AAAASF Random Case Peer Review forms and all Unanticipated Sequelae forms from your facility’s semi-annual or initial review.  California, New York and Florida facilities must complete Random Case Peer Review after completing their Provisional inspection. 

    • Random Review Form

    • Unanticipated Sequelae Form

    • A floor plan of your facility. This floor plan does not need to be to scale, but should clearly identify the dimensions and purpose for each room within the ASC. 

      •  Particularly the OR, Recovery Room, Dirty/Clean, Scrub Area, Exam, Nurse Station and Waiting Room(s).  All doors and exits should be identified.  

      A HIPAA Business Associate Agreement with the Facility Director’s signature and retain a copy for your files.

    • A copy of the Certificate of Incorporation

      • (Required for applicants in the state of New York only)

    • Standards and Checklist Booklets

    When the documentation is received in the AAAASF office it will be reviewed within ten (10) business days and you will be contacted if additional paperwork is needed.

    If you have any question or concerns, please feel free to contact the AAAASF office at 888-545-5222.