Medical Use

WISREG 1556 - Vol. 9 Revision 1- Guidance for Medical Use of Radioactive Material  (PDF, 6,307 KB)

 Application for a Radioactive Material License for Medical Use   - DPH 45008

• PDF Version (PDF, 33 KB)

• Form Fillable Version (Word, 179 KB)

Certificate of Disposition of Materials  - DPH 45007

• PDF Version (PDF, 2,705 KB)

• Form Fillable Version (Word, 46.5 KB) 

Training, Experience and Preceptor Attestations (DPH 45010 A-G)

• Attestation-A, (Radiation Safety Officer For Medical Use)

  • PDF Version (PDF, 45.1 KB)

  • Form Fillable Version (Word, 95.5 KB) 

• Attestation-B, (Authorized User -Written Directive Not Required)

  • PDF Version (PDF, 45.4 KB)

  • Form Fillable Version (Word, 96.5 KB) 

• Attestation-C, (Unsealed Radioactive Material Requiring A Written Directive)

  • PDF Version (PDF, 92.1 KB)

  • Form Fillable Version (Word, 135 KB) 

• Attestation-D, (Authorized User For Manual Brachytherapy Sources)

  • PDF Version (PDF, 58.1 KB)

  • Form Fillable Version (Word, 154 KB) 

• Attestation-E, (Authorized User Of Remote Afterloader, Teletherapy Or Gamma Stereotactic Radiosurgery Units)

  • PDF Version (PDF, 47.2 KB)

  • Form Fillable Version (Word, 97.0 KB) 

• Attestation-F, (Authorized Nuclear Pharmacist)

  • PDF Version (PDF, 36.8 KB)

  • Form Fillable Version (Word, 87.0 KB) 

• Attestation-G, (Authorized Medical Physicist)

  • PDF Version (PDF, 39.4 KB)

  • Form Fillable Version (Word, 80.0 KB) 

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