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 know, click here) NCI #:  
Name of person completing this form:  
Phone #:   Email address:    
Are you a:
Protocol to be credentialed:
Provide the RTF# for the radiation facility if different from above
RTF#: (Don't know, click here)
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?
For randomized photon vs. proton protocols, please list the RTF# of your partner proton center: (Don't know, click here)