CREDENTIALING FOR PROTOCOLS

This questionnaire will help determine if your institution is credentialed to participate in a protocol. IROC Houston will notify you
and the study group of your status. The study group or IROC Houston will inform your institution when it can participate in the
requested protocol. If you have any questions, please contact IROC Houston at (713) 745-8989 or
IROC-Credentialing@MDAnderson.org

Please note: You will be contacted via email or phone within 2 business days. Once we determine that all requirements are met, a credentialing email (PDF letter for a few protocols) will be issued within 5 business days.

Institution:   Study Group Name:
RTF#: (Don't known, click here) NCI #:
Name of person completing this form:    
  Phone #:   Email address:    
  Are you a:
Protocol to be credentialed:  
  Specify technique:  
Treatment planning system to be used for this protocol:  
Algorithm to be used for patient plans:  
Is your institution planning to use IGRT on this protocol, if applicable?