ABRET EEG Laboratory Renewal Form

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Renewing EEG Laboratory Accreditation requires the following:

Compliance with ACNS Guidelines and ABRET Accreditation Standards documented by signature with evidence of compliance in submitted recordings.
Submission of three EEGs (no LTM, ECI, or ambulatory recordings) selected by LAB-EEG for evaluation. Data should be de-identified and encrypted, according to institutional policy.
Submission of a $500 accreditation fee payable to ABRET. Visa and MasterCard accepted.
Submission of the required documentation and EEGs prior to the end of the year of expiration.

Goals:

To keep accredited labs aware of the expectations and standards.
To provide feedback on any changes that may affect accreditation status with suggested actions to maintain compliance.

Submission requirements:

Attachments must be appropriately labeled.

Please send one copy of each of the requested documents and EEG data, including patient histories on digital media (CD, DVD, flash drive) to the ABRET Office. If you would like to upload your data to a HIPAA-compliant server, contact the office for a link.

Reaccreditation Form for LAB-EEG Programs

Hospital/Institution

Laboratory Name:

Contact Person/Title

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Fax

Email Address

Medical Director Email Address

Medical Director Name and Address (if different)

Current Year *

Year of Initial Accreditation *

For any yes responses, include documentation/policies.

Since your accreditation, has your EEG Laboratory made any changes to its:

	Yes	No
Relationship between the laboratory and the hospital?	Yes	No
Scope of EEG services?	Yes	No
Examination administration procedures?	Yes	No
Data collection procedures?	Yes	No

In regard to your laboratory services, please answer the following questions:

	Yes	No
Has your laboratory discontinued any services?	Yes	No
Does your laboratory plan to add any new services?	Yes	No

Have there been any changes to the following policies and procedures? If yes, please submit copies.

	Yes	No
Staffing for technical personnel?	Yes	No
Testing Procedures?	Yes	No
Data collection procedures?	Yes	No
Has the staff changed in the past five years? If yes, submit a list of current staff.	Yes	No
Has there been a change in the Medical Director? If yes, send contact information and a copy of his/her license.	Yes	No
Does at least one of your current staff members hold an R. EEG T. credential?	Yes	No
Do you routinely record video with your EEGs?	Yes	No
Does your lab perform ambulatory EEG?	Yes	No

If yes, is your ambulatory outsourced? *

What are your requirements regarding credentials for staff? (Attach document or policy)

What are your continuing education requirements for staff? (Attach document or policy)

What quality assurance or quality improvement initiatives has your laboratory undertaken in the last five years? (Attach document or policy)

Please use this space to provide additional information.

Examination Data

Total # of procedures performed over the past five years

Example:
2019 - 53

	Year	Routine EEGs
-	Year	Routine EEGs
-	Year	Routine EEGs
-	Year	Routine EEGs
-	Year	Routine EEGs
-	Year	Routine EEGs

Attestation

I have read the ACNS Guidelines that pertain to EEG and the ABRET Expected Technical Standards for Records and that, to the best of my knowledge and belief, our EEG Laboratory complies with the Guidelines and Standards.

Director/Manager Name

Title

Date

Medical Director Name

Title

Date

Reaccreditation application received by ABRET after the initial accreditation has lapsed are not eligible to use this form to reestablish accreditation.

A fee of $500.00 is due with submission of the LAB-EEG Renewal Form *

Send check via mail

LAB-EEG Re-Accreditation Fee ($500.00)