Hi Marni, thanks for your inquiry. I'm going to refer you to a colleague of mine that I work with very closely. She's been AAERT certified and is more familiar with a lot of the U.S. requirements at this time than I am. I've primarily worked in the Canadian system up to this point and have been working with Stephanie to become familiar with the U.S. system. Her contact information is Stephanie McMeel, McMeel Transcription, phone 386-527-8993. I've asked her to contact you directly. Again, thanks for your inquiry, and I'm positive Stephanie will be pleased to work with you. Cindy.