This form allows submission of an HVA ReCertification Application online with payment of applicable recertification fee ($200/Member and $495/Lapsed Member*) by credit card.
*Lapsed member fee includes ASDIN membership for remainder of the membership year from date of recertification application.

We ask that the required documentation be assembled into one PDF document before submission and uploaded in space provided below.

Please note that the PDF file should be named using a standard format: Your Last Name_Your First Name_Type of Recertification.pdf.  Example:  Smith_John_HVA Recert.pdf.

Please Note:  The required Peer Letter must be submitted directly to ASDIN by the Peer Letter author (email, fax, or mail is acceptable).

If there are any issues in the upload/submission of this form, please use the following uplink  - https://spaces.hightail.com/uplink/asdin for file uploads and notify the ASDIN office at lfox@asdin.org.

DO NOT SEND PATIENT IDENTIFIERS IN ANY OF THE PAGES SUBMITTED. PLEASE REVIEW CASE/PROCEDURE NOTES, CASE LOG AND CQI DOCUMENTATION TO ASSURE THAT PATIENT NAMES ARE REMOVED. YOUR APPLICATION WILL BE RETURNED TO YOU AND WILL NOT BE PROCESSED UNTIL AN APPLICATION WITHOUT PATIENT IDENTIFIERS IS SUBMITTED.

If you would like to add Optional Advanced Procedures at time of Re-certification, you may select the additional $100 fee - here.