ION FOR AUTHORIZATION TO PERFORM RADIOLOGICAL PROCEDURES IN THE COMMONWEALTH OF PENNSYLVANIA INSTRUCTIONS: 1) Upon successful completion of the Radiation Health & Safety (RHS) examination through the Dental Assisting National Board, Inc. (DANB), please complete this form in its entirety and return the completed form to the address listed above. 2) Attach a check or money order in the amount of $75.00 made payable to the “Commonwealth of PA”. DO NOT SEND CASH. Fees are non-refundable. Note: A.
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How to fill out the PA Application for Authorization to Perform Radiological Procedures online
This guide provides step-by-step instructions on how to complete the PA Application for Authorization to Perform Radiological Procedures online. Whether you are familiar with online forms or a first-time user, this guide will support you in filling out the application accurately.
Follow the steps to complete your application efficiently.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter your personal information in the fields provided. This includes your last name, first name, and middle name. Ensure accuracy as this information will be used for official purposes.
- Fill in your address details, including the street, city, state, and zip code. Double-check these entries to ensure they are correct.
- Provide your social security number in the designated format (XXX-XX-XXXX). This is required for identification purposes.
- Input your date of birth using the format month/day/year. This helps verify your eligibility.
- Enter your phone number in the area code and number format. This allows the board to contact you if needed.
- Include your email address. Make sure it is current as important updates will be sent to this address.
- Indicate the examination date, as it is essential for processing your application.
- Attach a check or money order for $75.00 made out to 'Commonwealth of PA'. Remember, cash should not be sent.
- Ensure that all information is complete and accurate before saving your changes. You may then download or print your application for submission.
- Retain a copy of the submitted application and the payment confirmation for your records.
Start filling out your PA Application for Authorization to Perform Radiological Procedures online today!
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