ABRET EEG Laboratory Accreditation Processing Form

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New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.

Date *

Hospital/Institution *

Laboratory Name: *

Name/Title Person Completing This Form *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Fax

Email Address *

Medical Director and Email Address (and mailing address if different)

Administrator/Title and Address (if different)

Number of EEGs per year, performed by your lab (approximately) *

Check the procedures performed in your lab

Adult EEG

Pediatric EEG

Neonatal EEG

Sleep Deprived

ECI

Bedside

Other

If other, please list

+-

Do you routinely record video with your EEGs? *

If your lab performs ambulatory EEG, is it outsourced? *

Laboratory Documentation

Please Submit the following supporting documentation

1. Copy of the Medical Director's state medical license *

2. A list of all staff technologists including credential status and registry numbers *

3. List of staff continuing education activities in the last 12 months (Please do not upload certificates or multiple transcripts) *

ABRET EEG Laboratory Accreditation Application

General Information

The Laboratory Accreditation Board of ABRET (LAB-EEG) is a seperate board fuctioning under ABRET, Inc., a not-for-profit, 501 c6 corporation.

Any Laboratory performing clinical EEGs interpreted by a licensed physician (M.D. or D.O.) may apply for accreditation.

At least one of the staff technologists must be an R. EEG T. or Canadian RET.

LAB of ABRET requires a formal review of laboratory output and Policies & Procedures.

The EEG interpretation (professional component) will not be evaluated.

Submitted records will be returned or destroyed in a HIPAA-compliant manner after the process is complete.

A site visit will not be conducted.

Accreditation will be for 5 years.

A list of ABRET accredited EEG laboratories will be published on the ABRET website.

Successful laboratories will receive a framed certificate, digital badge, and a press kit.

Unsuccessful labs may reapply in one year.

** Once this Processing Form is received, ABRET will email the point of contact listed above to request items for Step II of the application process, including a list of policies and EEG recordings selected by dates defined by the Board.

A Business Application Agreement must be completed to satisfy HIPAA requirements. This information may be completed on pages 7–9 of the LAB-EEG Manual and emailed to anna@abret.org. If your facility requires use of its own business agreement instead, please send a copy to Anna Bonner at anna@abret.org.

A fee of $100.00 is due with submission of the Part I Processing Form. *

Send check via mail to ABRET, 111 E. University Drive, Ste 105-355, Denton, TX 76209

LAB-EEG Application Fee ($100.00)