ABRET EEG Laboratory Accreditation Processing Form

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Date of Application * +

Hospital/Institution *

Laboratory Name: *

Name/Title Person Completing This Form *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

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)