Get Rc252-2b.doc. Forms And Forms Information - Dshs State Tx

Filling out the Rc252-2b form is an essential task in applying for a RAM license in Texas. This guide provides a step-by-step approach to facilitate accurate completion of the form, ensuring all required information is submitted efficiently.

Follow the steps to successfully complete the preceptor statement form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by providing the applicant’s full name and address in the designated fields. Ensure the information is typewritten or clearly printed for legibility.
3. Fill in the dates of training to document the timeline of the applicant's clinical experience effectively.
4. In Column A, list the radionuclides that the physician has experience with by checking appropriate boxes for the radionuclides used during their training, such as Tc-99m or I-131.
5. In Column B, specify the conditions that have been diagnosed or evaluated using the radionuclides listed in Column A. This should reflect the applicable training experiences.
6. For Column C, input the number of cases involving personal participation related to each radionuclide and condition. This is crucial for demonstrating hands-on experience.
7. Use Column D to provide any additional comments or relevant information that may support the application or clarify experiences.
8. Proceed to page two of the form and repeat steps in Columns A, B, C, and D, focusing on treatments rather than evaluations for the second section.
9. Calculate and fill in the total hours of clinical training combined with work experience, ensuring accuracy in these figures. List the institution where this training was acquired.
10. Document the total hours of didactic (classroom and laboratory) training, specifying where the training was attended.
11. If applicable, complete the sections regarding residency or board specialty, providing the necessary details as required.
12. Finalize the form with the preceptor's certification, including the name, signature, institutional information, and contact details.
13. After review, save any changes made to the document. You may print, download, or share the form as needed.

Complete your documents online to ensure a smooth application process.