ABRET EEG Laboratory Renewal 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.

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), the dates for which will be selected by the LAB-EEG Board for evaluation. Data should be de-identified and encrypted, according to institutional policy. Contact anna@abret.org for EEG recording dates.
Submission of a $700 accreditation fee payable to ABRET. Most major credit cards are accepted.
NOTE: If mailing the fee by check, please ensure that “LAB-EEG” or an invoice number is included in the memo section of the check and mail to the ABRET Executive Office (111 E. University Drive, Ste. 105–355, Denton, TX 76209).
Submission of the required documentation and EEGs are due prior to the end of the expiration year.

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.Use the Record ID Form to help reviewers properly identify your recordings.
Please send one copy of each of the requested documents and EEG data, including patient histories, on digital media (CD, DVD, USB/flash drive) to Anna Bonner (2054 Kildaire Farm Road, #431, Cary, NC 27518).
If you would like to upload your data electronically to a secure HIPAA-compliant server versus sending these items by mail, please contact anna@abret.org 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

Email Address

Medical Director Name and Title (if different than the main contact):

Medical Director Email and Mailing Address (if different than main contact):

Current Year *

Year of Initial Accreditation *

For any yes responses, include documentation/policies.

Since your accreditation, has your EEG Laboratory made any changes to the following and if so, please submit copies of your updated policies & procedures:

	Yes	No
Relationship between the laboratory and the hospital?	Yes	No
Scope of EEG services?	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 OR send an updated copy if it expired within the last 5 years.	Yes	No
Does at least one of your current staff members currently 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

Upload policies here

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

Report the total number of routine EEG procedures performed on an annual basis 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 applications received by ABRET after the initial accreditation has lapsed are not eligible to use this form to reestablish accreditation.

All renewal documents and EEG records must be received by December 31 the year of expiration.

Please mail your check to the Executive Office for processing:

ABRET Executive Office

111 E. University Dr., Ste. 105–355

Denton, TX 76209

Please mail your EEG records and all other materials to the following for review:

ABRET LAB-EEG

2054 Kildaire Farm Road, #431

Cary, NC 27518

A fee of $700.00 is due with submission of the LAB-EEG Renewal Form *

Send check via mail

LAB-EEG Re-Accreditation Fee via credit card ($700.00)