Get Medicalinstructions.doc - State Of Illinois - State Il

Filling out the MedicalInstructions.doc for the State of Illinois requires attention to detail and accurate information. This guide will walk you through each section of the form to ensure you complete it correctly.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to access the form and open it in your chosen editor.
2. Begin by selecting the type of renewal application. Check the appropriate box for either Portable Gauge or Portable X-Ray Fluorescence Analyzer (XRF) and fill in your license number.
3. In ITEM 2, provide the applicant's name and mailing address clearly and completely.
4. ITEM 3 requires the name and contact information of the person authorized to act on behalf of the licensee. Include two phone numbers, two fax numbers (if applicable), and email addresses.
5. For ITEM 4, list the address(es) where radioactive material will be used. Mark whether it's stored, used and stored, and if there are any temporary jobsites (≤ 180 days). Confirm ownership or notify the owner of the property as required.
6. For ITEMS 5 through 17, review your radiation protection program. You will need to provide relevant updates, training information of individuals who will use radioactive material, and confirm that the operational procedures are reflective of current regulations.
7. In ITEM 18, no fee payment is required at this time. Your agency will bill you for the appropriate fee category and job sites.
8. ITEM 19 pertains to financial assurance. Check the relevant box as per the requirements set out in the regulations.
9. Complete the certification section in ITEM 20. Your signature and date are required to certify the truthfulness of the information provided. If you are applying as an individual, answer the questions regarding educational loans and child support obligations.
10. Finally, review all the provided information for accuracy. Save changes, download, print, or share the completed form as necessary.

Take action now and complete your application online to ensure timely processing.