Prior Authorization for Ambulatory and Video Electroencephalography

Form Template

After a routine EEG report, a patient may need further evaluation.

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In cases of seizures, catching images of the brain activity while a seizure is in progress may be helpful for a diagnosis of epilepsy, which is what an Ambulatory and Video Electroencephalography test will do. The evaluation will record the brain waves and activity so doctors can correctly which types of epilepsy are impacting the patient and prescribe the proper antiepileptic drugs. The evaluation can be done in a clinical setting or as an outpatient procedure. The Prior Authorization for Ambulatory and Video Electroencephalography app should be completed by a doctor and patient prior to the Video EEG. This will allow the EEG technologist to conduct the evaluation for the diagnosis of seizures.

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