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Get State Of Indiana Radiation Machine Facility Registration Form

Reset Form RADIATION MACHINE REGISTRATION APPLICATION PART A - GENERAL FACILITY INFORMATION AND AGREEMENT State Form 9977 R5 / 2-10 INDIANA STATE DEPARTMENT OF HEALTH MEDICAL RADIOLOGY SERVICES FOR OFFICIAL USE ONLY New Facility Update Facility new machine new location etc. Routine Inspection In accordance with regulations promulgated under authority of IC 16-41-35 each person having one or more radiation machines shall apply for registration of .

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