Get Form Iemaflm 001m Supplement A1

Filling out the Form Iemaflm 001m Supplement A1 online can seem daunting, but understanding each section will make the process easier. This guide provides clear and detailed instructions to help users complete the form accurately and effectively.

Follow the steps to complete the Form Iemaflm 001m Supplement A1 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This allows you to start the process of filling out the form online.
2. Begin with Part I, where you will input the proposed authorized user's name, Illinois medical license number, and pending radioactive material license number.
3. In Part I, indicate the desired authorization(s) by checking all applicable boxes, including Manual Brachytherapy, Ophthalmic use of Sr-90, and any other emerging technologies, if necessary.
4. Proceed to Part II(A) if the proposed individual has previously been licensed. Provide the name of the medical institution, address, and contact information of the Radiation Safety Officer (RSO). You must also include the institution's radioactive material license number.
5. If applicable, move to Part II(B) for board certification. Specify the board details and submit evidence of each certification. Ensure that any required attestations from supervising authorized users are included.
6. If not previously licensed, or if seeking additional authorizations, move to Part II(C). Document structured training and experience, including hours of training and work, along with the supervising AU's signature.
7. In Part III, the requesting licensee or representative must certify the information provided. Fill in their name, title, and date, and ensure they sign the section.
8. Review all completed sections for accuracy. Once satisfied, you can save the changes, download the form, print it out, or share it as needed.

Start filling out your Form Iemaflm 001m Supplement A1 online today!