Application for MIBB membership in case of an accredited center

Institution

Address

Town

Zip code

Head of institution

phone

E-Mail

Responsible physician for VAB at the applying institution:

Name:

Position:

Phone

E-Mail

MIBB-/accrediated:yesno

New member application together with the institute application:yesno

Please additional fill out the application form for individual MIBB-membership

Are there further physicians performing VAB at the applying institution? yesno

Further physicians performing VAB at the applying institution:

Name:

Email:

MIBB-accreddiated: yesno

Name:

Email:

MIBB-accreddiated:yesno

Name:

Email:

MIBB-accreddiated: yesno

Please fill out a separate application form of MIBB-membership for any individual physician not yet accredeted

Technical Equipment available for VAB at the institution:

Stereotactic / DBT table:

availableused for VAB

Stereotactic / DBT upright:

availableused for VAB

Sonographic VAB system:

availableused for VAB

MRI coil and biopsy device:

availableused for VAB

Interdisciplinary cooperation:

Diagnostic imaging:

availableexternal cooperation

Pathology
(that operates according to the guidelines of the Swiss Society of Pathology):

availableexternal cooperation

Gynecology / Oncology:

availableexternal cooperation