The online application is to recertify a healthcare center and individual provider(s) for a six year period.  The RLS Foundation’s Scientific and Medical Advisory Board (SMAB) will review application materials submitted against all certification criteria.  For technical assistance in completing the application, contact Executive Director, Karla Dzienkowski (karla@rls.org) or by phone at 512.366.9109.
The following organizational capabilities shall be provided by the Quality Care Center Director in order to recertify your center. This includes:
  • QCC Director to review organizational capabilities and note if any changes in diagnostic and therapeutic services, center infrastructure or certified provider status. 
  • New provider candidates for consideration during recertification of QCC are required to submit proof of CME/Alternative CME, CV or Biosketch, affirm care of 50 unique RLS patients and fulfill all clinician eligibility requirements as outlined in Section 1 of the  QCC Certification Application. New clinicians to submit information here: https://www.surveymonkey.com/r/QCCClinician

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* 1. Quality Care Center Name and Location

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* 2. QCC Director Name

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* 3. Director holds and MD or PhD (or PhD equivalent) degree

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* 4. $500 recertification fee paid by:

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* 5. QCC Center Coordinator Name and email

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* 6. List all clinicians to be re-certified. Please direct them to submit clinician re-certification requirements here: https://www.surveymonkey.com/r/QCCClinicianReCert

Organizational Capabilities. QCC Director to review organizational capabilities and note if any changes in diagnostic and therapeutic services, center infrastructure or certified provider status.

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* 7. Are there any changes in diagnostic and therapeutic services?

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* 8. Are there any changes in center infrastructure?

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* 9. Are there any new clinicians to be certified?

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* 10. List any new clinicians to be certified, please direct them to submit a request for certification here: https://www.surveymonkey.com/r/QCCClinician

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* 11. Please provide any additional Comments or Questions.

The SMAB committee will make a recommendation to the RLS Foundation Board of Directors who will decide upon the applicants recertification. Once recertified, the Foundation will continue to list the QCC and each certified provider on the Foundation’s website (www.rls.org) as a member of the RLS Certified Quality Care Center Network. Certified providers will receive an RLS Foundation membership and be listed individually on our Health Care Provider Directory.
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