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Petition of Eligibility for CNIM
 

Your Information



Employment Information



NIOM Education

 YesNo
Did you have didactic (classroom) training?
Did you have clinical training with supervision?
Did you participate in monitoring sessions with a senior technologist?
Did you participate in case review sessions with a physician?
Were you required to take a final exam at the end of your training period?
Are you able to monitor NIOM cases independently?
Have you completed documentation of 150 cases?
Years of experience in neurodiagnostics: *
Percent of time currently spent working in Neurophysiologic Monitoring: *
Indicate any of the following procedures you personally record in the operating room: *

 

 

 

 


Other Healthcare Education

 YesNo
Did you have didactic (classroom) training?
Did you have clinical training with supervision?


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