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Applicant
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First Name:
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M.I.:
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Last Name:
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Credentials:
(check all that apply)
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R.NCS.T. Registration Number (if checked above)
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R.NCS.T. year taken (if checked above) [yyyy]
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Primary Address
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Street 1:
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Street 2:
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City:
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State:
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Postal Code:
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Alternate Address
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Street 1:
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Street 2:
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City:
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State: |
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Postal Code:
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Contact
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E-mail Address:
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Confirm E-mail:
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Phone Number:
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Alternate Phone:
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Fax Number:
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Security
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Enter Password:
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Confirm Password:
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Is it OK if we e-mail you information from time to time?
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No, thanks
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Training in Electrodiagnostic Procedures
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Was your training under an AANEM physician Neurologist or PMR?
Yes
No
If yes, Name of Physician:
Physician's Specialty:
Are you currently employed as an electrodiagnostic technologist performing
non-invasive nerve conduction studies as a nerve conduction study technologist
or technician?
Yes
No
How long have you been performing NCS?
Are you interpreting the NCS?
Yes
No
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Employment directly related to your experience as a technologist
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List experience that applies to nerve conduction studies:
Types of Procedures or duties you perform(ed) (check all that apply):
MD Supervisor of Lab/Office:
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The Code of Ethics of the
American Association of Electrodiagnostic Technologists
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As a Member of the American Association of Electrodiagnostic Technologists,
I subscribe to this Code of Ethics.
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In my work I will act in a manner so as to merit the respect of the public,
those providing medical care to the public, and my fellow AAET Members.
- I will not at any time perform independent needle EMG examinations.
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I will not at any time provide a written clinical interpretation derived from
the procedure, which I have carried out.
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I will maintain the confidentiality of any information about any patient,
including the results of any tests carried out on the patient.
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I will treat all patients with the utmost respect and courtesy, regardless of
their sex, race, creed, or the nature of their presenting disease.
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I will strive to achieve excellence in my work, and to assist other technologists
to do the same.I understand that by becoming a member bound by the code of ethics,
and that I am required to rules and regulations established from time to time by the
Board of Directors of the American Association of Electrodiagnostic Technologists.
If I am bound by the Board of Directors and have violated this code of ethics or any
rules and re gulations of the Association, the Board of Directors may revoke my
membership, and I may no longer represent myself as a member of the American
Association of Electrodiagnostic Technologists.
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