GE LOGIQ 200 Quality Assurance Manual page 186

Filling out the ACR Accreditation Forms
If you marked "Change" for any QC
test on this application, proof of
corrective action must be attached
with the submittal forms for ACR
Accreditation.
Get this info from the Gray Scale
Test on page 5 of the QA
Procedure.
Answer these eight questions
Yes or No from page 3 of the QA
Procedure.
1 February, 2000
Fill in site information and date. Report
date is the date this application was
filled out. Survey date is the date of
this QA check.
Print your name, sign it and check
Service Engineer.
Enter GE Medical Systems as the
manufacturer and enter model from the
system rating plate.
GE Medical Systems has permission
from the ACR to reprint these forms.
2