This article provides instructions and tips for completing and submitting the Annual Facility Form.
The Annual Facility Form must be submitted upon initial registration and at the beginning of each subsequent calendar year. The form must be submitted before manually submitting any other GRID forms.
A printable Annual Facility Form is available for your workflow processes and should not be submitted to the ACR.
Prior to completing the form, review the Manual Data Entry Overview for helpful tips on completing the manual forms. Also, refer to the GRID Data Dictionary for details about each data element.
This field is populated automatically, as determined by the user’s profile
Enter the calendar year for which you will be entering data, other than data specifically requested for the previous year. For example, if you enter 2017 in this field, then you should complete the number of admissions, the number of radiography exams, and all other fields for which previous year data are requested, using 2016 data. All other fields, such as Case mix index and Number of FTE radiologists, should be completed using 2017 data.
If your facility is a hospital, then enter data for the number of admissions during the previous calendar year and the case mix index. Otherwise, check Not applicable.
Enter the number of procedures of each type performed at your facility during the previous calendar year. If a procedure is not normally performed at your facility, check Not applicable.
Enter the number of personnel of each type employed at your facility. This includes staff outside the radiology department (e.g. cardiac) and assistants that perform front-office functions in addition to technologist’s functions. You should keep this information up to date if it changes during the year. Choose the appropriate response for questions regarding certification requirements at your facility.
Note: The CT Certification or MRI Certification questions will be disabled if you checked Not applicable for those modalities in the Volume section.
Enter the number of incidents of each type that occurred at your facility during the previous calendar year. This section is disabled if you checked Not applicable for MRI in the Volume section.
Enter the number of incidents of each type that occurred at your facility during the previous calendar year.
Choose the appropriate response for each question.
Note: Some choices are disabled, depending on whether you checked Not applicable for the corresponding procedures in the Volume section.
Indicate whether a written protocol exists for each event or condition.
Enter the number of ACR accredited units, the number of units pending ACR accreditation, and the total number of units at your facility for each equipment type.
Name of the person who completed this paper form
If this name has not been previously entered for this field for a previous GRID form, select Add New and enter the person’s first and last name. In the future, the name will appear in the drop-down list for this field. If the name has been previously entered, click the arrow and select it from the drop-down list.
Note: Please populate this field even if paper forms were not used; you may use the name of the person completing the on-line data submission.
To delete a name from the list, select it and then click the Delete Person button.
Name of person submitting form
These fields are filled in automatically.
Click the Submit button. You must correct any errors before the form will be accepted. If no errors are detected, a confirmation message appears and the form moves to Completed status.
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Monthly Data by Facility