The flow chart of the process of a typical hospital evaluation & grading in Iranian Healthcare System, adapted from Aryankhesal (2010) . Figure 1 Shows the flow chart of the process of a typical hospital evaluation and grading (scoring) in the Iranian health care system. According to the regulations, hospital emergency departments (ED) and Critical Domains (CD) are evaluated first and only the rest of the hospital would be evaluated if the ED and CD are awarded at least grade 3. If the ED and CD are qualified, the evaluation and scoring of all parts of the hospital will start. If the whole hospital is qualified, calculation of scores and defining the grade will be conducted by an assessment team. The grade as determined by the assessment team should be approved by the university’s Vice-chancellor for Treatment, university Chancellor, university’s Evaluation & Supervision Council and finally by the MOHME.