Get Form Iema.flm-001m Supplement A.7 - State Of Illinois - Iema Illinois

Filling out the FORM IEMA.FLM-001M SUPPLEMENT A.7 is a crucial step in documenting the training and experience of an authorized medical physicist. This guide will provide a clear and supportive approach to completing the form online, ensuring that you understand each section and field.

Follow the steps to complete the form accurately and efficiently.

1. To obtain the form, click the ‘Get Form’ button to access and open it in your chosen online editor.
2. In Part I, provide the name of the proposed authorized medical physicist and the pending radioactive material license number. Be sure to check all applicable authorizations for desired training references from the provided list.
3. In Part II(A), if applicable, indicate whether the proposed individual has been previously licensed as an authorized medical physicist. Supply all required details, including the medical institution, its address, and the radioactive material license number.
4. If using the board certification method in Part II(B), specify each board certification and include evidence, such as photocopies, of each certification. Ensure to include the attestation from the supervising authorized medical physicist.
5. For the structured training and experience method in Part II(C), provide details of the training and experience under the supervision of an authorized medical physicist, including hours and dates for clinical training and work experience.
6. After filling in all sections and double-checking for accuracy, you can save changes, download, print, or share the form as needed.

Begin filling out your documents online today to ensure a smooth and timely submission.