Get Radiation Machine Registration Application - Department Of Public ... - Dphhs Mt

Registering your radiation machine is an essential step to ensure compliance with state regulations. This guide will help you navigate the process of filling out the Radiation Machine Registration Application in a clear and straightforward manner.

Follow the steps to complete your registration application online.

1. Press the ‘Get Form’ button to access and open the application form in your preferred online editor.
2. Enter the 'date' at the top of the form to indicate when you are submitting the application.
3. Fill in the 'facility/owner name' field with the name of the individual or entity that owns the radiation machine.
4. Provide your complete 'address,' including street, city, state, county, and zip code.
5. Input your contact information by including your 'telephone' and 'fax' numbers.
6. Select the 'type of facility' where the radiation machine will be used by checking the appropriate box: hospital, clinic, private office, or other.
7. Choose the 'type of practice' that applies to your facility, such as dental, physician, podiatry, or other.
8. Fill in the 'work-load' section by indicating the number of exams performed each month in the provided box.
9. Provide the 'name and position of the person filing the application.' An electronic signature will be required if submitting online.
10. List the 'name of Radiation Protection Officer' and their position, if applicable.
11. Complete the section regarding any used machines, including previous owner's name and address, and acquisition date.
12. Document any transactions involving sold x-ray machines, including details about the machine and receiving party.
13. For each radiographic machine, fill in the corresponding fields including model, manufacturer, serial number, classification, and whether the machine is new or existing.
14. Review all entries for accuracy and completeness before final submission.
15. Once completed, save your changes and download, print, or share the form as needed.

Take the first step in registering your radiation machine by completing the application online today.