PART IV - LEVEL 2 HOSPITAL Instruction: In the appropriate box, place a check mark () if he hospital is compliant or X-mark i ot compliant ATTACHMENT 2.A - PERSONNEL. ‘TOP MANAGEMENT (Should be fulltime) ChieFof + Tieened physician | DOCUMENT REVIEW 7 HospialMedical | + Have completed at | DiplomalCerifcate of Director least twenty (20) ‘units earned ants towards | « Updated Physician PRC fs Maners Degreein | tense YO Hospi + Cetiats of Trainings ear Manion | a related course * Proof of Employ it (MPH, MBA, MPA, |” Appointment notarized) MHSA, etc.) AND | 5 Service atleast ive 8) Record/Ceriiate of years hospital Employment (proof of Soulaleias Bevior supervisory or supervisory/managerial aot oe 2 ChiaFoFCinies7 [> Licensed physician | DOCUMENT REVIEW i Chief Medical | Fellowidplomate of | » Diploma/Certeate Professional ‘a specialty/ from Specialty society Serion subspecialty society | nated PRC tcnse © Atleast five (5) jam taal * Certificates of Trainings ~ experience in a attended Clinical supervisory | * Proof of Employment / of managerial Appointment Position, (notarized) Record/Cetieate of Employucat (roof of clinical supervisory/managerial experience in hospital) ‘Department Head ‘Licensed physician | DOCUMENT REVIEW I per (Specialty) Fellow /diplomate |» Diploma/Certificate department in a specialty / from Specialty society Subspecialty society |, Updated PRC license Yv of the department te + Certificates of Trainings sed « Pref of Employment / apace (notarized) ‘Chief Nurse/ Licensed nurse DOCUMENT REVIEW 1 Director of Nursing | # Master's Degree in | * Diploma Megane |= Spd Pome Isat ee yeas | © Cerificate of Tinings U otelinical attended comieedes __ [5 Soeciat iowa i 3