Credentials The international health care organization owner contact’s credentials to be specified with their name, e.g., MD, MH, MBA, etc.

Demographic Information The information regarding the international health care organizations name, location, and means of contact.

Family Name The name shared in common to identify the members of a family, as distinguished from each member's given name. Also called “Surname” or “Last name”.

Full Name The international healthcare organization owner contact's complete name including first name(s), middle name(s), and last name(s).

Given Name The first name of a person; name given at birth or baptism, as distinguished from the surname. Also called “Forename”.

JCI Contact Type CEO or Survey Coordinator

Organization The international health care entity applying for accreditation or certification.

Prefix The preferred and appropriate social title preceding the international health care organization owner’s contact name, e.g., Miss, Mr., Ms., Dr., etc.

Security Administrator The contact person responsible for identifying the individual that will be assigned key responsibilities during the accreditation/certification process and authorizing their access to the electronic application.

Title The international health care organization owner contact’s official organizational title, i.e., CEO, President, Director General, etc.

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Demographic Information
Organization Name
(Enter your organization name in the entry text box below)

Address Line 1
Street Address
Address Line 2
P.O. Box, Building, Floor, etc.
Postal Code
Main Telephone Number
Country Code City Code Number Extension
Organization Website

JCI Accreditation Role
Prefix Full Name
Type your full name as it would be written
Given Name
Family Name
If the populated name in this box differs,please modify
Title Credentials
Mobile/Cell Number
Country Code City Code Number
Email Address
Alternate Email Address
English Speaking

Please include telephone country code and if available city code.

Organization name cannot exceed 120 characters.

The security administrator is an individual employed with the organization.

The State/Province/Prefecture/County field becomes enabled based on the country selection. If the field is disabled our data indicates the country selected does not have State/Province/Prefecture/County.

You may apply for JCI accreditation or certification if your CEO or Accreditation Survey Coordinator do not speak English. However, speaking English will help simplify communications between your organization and JCI Accreditation, so JCI strongly encourages its organizations to designate an English-speaking primary contact.