Washington State Department of Health Acute Care Hospital License

Valid until April 5, 2022

All acute care or general hospitals are licensed by the state to provide care within the minimum health and safety standards established by regulation and rule. The Department of Health enforces the standards by conducting periodic surveys of these facilities.

Joint Commission

Accredited June 19, 2021 (valid for up to 36 months)

Joint Commission Gold Seal

A hospital may seek accreditation by an approved accrediting body such as the Joint Commission. The Joint Commission is the nation's largest not-for-profit health care regulating organization. The Joint Commission* is an accrediting agency that evaluates the quality and safety of care for more than 15,000 health care organizations.

Additional Joint Commission certifications:

  • Advanced Primary Stroke Center 
    Accredited through February 2022 (valid for up to 24 months)
    The Joint Commission's Certificate of Distinction for Primary Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. Achievement of certification signifies that the services we provide the critical elements to achieve long-term success in improving outcomes. It is the best signal to our community that the quality care we provide is effectively managed to meet the unique and specialized needs of stroke patients.
  • Joint Replacement - Shoulder, Hip and Knee
    Certification current through March 2020
Washington State Department of Health Level II Acute Care Trauma Center

Designation through June 2027

In 1995, Washington State established a five-level trauma system using designations established by the American College of Surgeons. The higher the level, the more highly trained the staff and the more advanced the facility, with Level I being the highest achievable. As a Level II Trauma Center, Kadlec Regional Medical Center meets the state's criteria for high level of 24-hour trauma emergency, operative and critical care services. It provides prompt assessment, resuscitation, emergency surgery and stabilization of trauma victims.

Washington State Department of Health Level III Pediatric Trauma Center

Designation through June 2027

College of American Pathologists (CAP) Lab

Certification through December 2022

This mark demonstrates that Kadlec’s laboratory provides quality care under the auspices of the CAP accreditation program requirements and is a symbol of excellence. CAP is a medical society that serves more than 17,000 physician members and the laboratory community throughout the world. It is the world's largest association composed exclusively of pathologists and is widely recognized as the leader in laboratory quality assurance. The CAP is an advocate for high quality and cost-effective patient care.

American College of Surgeons Commission on Cancer

Certificate with Commendation through September 2021

Commission on Cancer logo

The cancer program at Kadlec Regional Medical Center has earned three-year accreditation with commendation by the American College of Surgeons Commission on Cancer. This accreditation assures patients that they are receiving care that meets the highest standards.

Commission on Accreditation of Rehabilitation Facilities (CARF)

Accredited through October 2023

CARF is an independent, nonprofit organization focused on advancing the quality of services used to meet the needs for the best possible outcomes for patients. CARF provides accreditation services worldwide at the request of health and human service providers. Providers that meet their standards have demonstrated their commitment to being among the best available.

American College of Radiology (ACR)

Accredited May 25, 2021 - September 18, 2024

Gold seal Radiology

With these accreditations, Kadlec has been designated a Breast Imaging Center of Excellence (BICOE). Designation is awarded to breast imaging centers that achieve excellence by seeking and earning accreditation in all of the ACR’s voluntary breast-imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program.

Additional American College of Radiology Accreditations:

  • Mammography, Outpatient Imaging Center
    Accreditation through September 18, 2024
  • Stereotactic Breast Biopsy Imaging Services
    Accreditation through May 22, 2023
  • Breast MR Imaging Services
    Accreditation through March 30, 2024
  • Breast Ultrasound and Ultrasound Guided Breast Biopsy
    Accreditation through August 21, 2023 
American Diabetes Association, Diabetes Education Program

Certified through September 2021

The American Diabetes Association certification assures patients they are receiving state-of-the-art information about diabetes management from expert staff. The certification gives professionals a national standard by which to measure the quality of the services they provide and it helps consumers identify these quality programs.

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)

Certification through August 31, 2020

The AACVPR Cardiac and Pulmonary Rehabilitation Program Certification process is the only peer-review accreditation process designed to review individual facilities for adherence to standards and guidelines developed and published by the AACVPR and other professional societies. AACVPR certification demonstrates Kadlec’s program is aligned with current guidelines as approved by the AACVPR for the appropriate and effective early outpatient care of patients with cardiac or pulmonary issues.

Oncology Accreditations

APEx (Accredited through ASTRO)

The mission of the ASTRO Accreditation Program for Excellence (APEx®) is to recognize facilities by objectively assessing the radiation oncology care team, policies and procedures and the facility. APEx was created to support quality improvement in radiation therapy practices. The APEx Program applies standards of performance derived from white papers and consensus practice guidance for radiation oncology. Facilities that obtain APEx practice accreditation must demonstrate that their systems, personnel, policies, and procedures meet the APEx standards for high-quality patient care. The APEx Program provides an objective review by professional peers of essential functions and processes of radiation oncology practices (ROPs). It offers transparent, measurable, evidence- and consensus-based standards that emphasize a professional commitment to safety and quality.

Radiation oncology practices accredited by ASTRO will:

  • Undergo an objective, external review of radiation oncology practices, policies, and processes.
  • Demonstrate respect for protecting the rights of patients and being responsive to patient needs and concerns.
  • Adopt procedures to encourage safety and quality of care.
NAPBC (Accredited through American College of Surgeons)

The National Accreditation Program for Breast Centers (NAPBC) represents a consortium of national, professional organizations dedicated to the quality of care of patients with diseases of the breast.

To achieve its mission, the NAPBC works to:

  • Provide a framework for the delivery of high-quality care for breast disease through standard setting, quality measures, clinical trial participation, and professional education.
  • Develop consensus-based, patient-focused standards for breast centers and a site visit process to monitor compliance.
  • Expand programs of quality improvement and benchmark comparison.
  • Develop educational programming on the standards, site visit process, and best practices to enhance center performance.
  • Promote patient advocacy through community outreach.
  • Leverage strategic partnerships and enhance collaborations to promote the NAPBC.
  • Recruit, retain, and promote NAPBC centers.
NAPRC (Accredited through American College of Surgeons)

Kadlec was the first program to achieve NAPRC Accreditation in the State of Washington and is one of only 33 programs in the country.

The National Accreditation Program for Rectal Cancer (NAPRC) was developed through a collaboration between The OSTRiCh Consortium (Optimizing the Surgical Treatment of Rectal Cancer) and the Commission on Cancer (CoC), a quality program of the American College of Surgeons.

The NAPRC’s goal is to ensure patients with rectal cancer receive appropriate care using a multidisciplinary approach. The NAPRC is based on successful international models that emphasize:

  • Program Structure - Establishing a rectal cancer multidisciplinary team comprised of trained and qualified physicians and coordinators
  • Patient Care Processes - Researching supported protocols and processes for rectal cancer care
  • Performance Improvement - Data collection and monitoring to track care processes, treatment, compliance, and patient outcomes
  • Performance Measures - Verifying adherence to evidence-based procedures, including total mesorectal excision, pathological assessment, and MRI staging and reporting
Quality Oncology Practice Initiative (QOPI)

Certification through September 20, 2022

Quality Oncology Practice seal

Kadlec Clinic Hematology and Oncology is a QOPI® Certified Practice. The Quality Oncology Practice Initiative certification serves as a designation from the QOPI Certification Program (QCP™), an affiliate of the American Society of Clinical Oncology, for hematology-oncology practices that meet defined quality and safety standards. QCP provides a three-year certification to high-performing practices, and requires ongoing participation in data abstraction, as defined by QCP in the QOPI® program throughout the three-year term. To learn how an oncology practice achieves QOPI® Certification, visit