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Mammography certification form 2025

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The document is an application form for Mammography Facility/Machine Certification from the California Department of Public Health's Radiologic Health Branch. It includes sections for facility status, information, accreditation history, procedure details, personnel qualifications, equipment information, and a medical physicist report. The form requires detailed information about the facility's operations, personnel qualifications, and compliance with state regulations to ensure safe and effective mammography services.

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Click ‘Get Form’ to open the mammography certification form in the editor.
Begin with Section 1, where you will indicate the type of facility and reason for submission. Check the appropriate boxes and provide your State Registration Number.
In Section 2, fill out your facility information including name, contact details, and addresses. Ensure all fields are completed accurately.
Proceed to Section 3 to detail your facility's accreditation history. Answer the questions regarding previous applications and any denials or suspensions.
In Section 4, provide information on the number of procedures performed at your facility. This includes screening, diagnostic, and therapeutic procedures.
Complete Sections 5 through 9 by detailing associated program information, personnel qualifications, equipment details, and finally acknowledging and certifying the information provided.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (267 Votes)
2007	4.4 Satisfied (256 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a mammography certification number?

The most common misconception about mammography is that it is easy and a non-thinking job. When students start hands-on training, they are always surprised to see how difficult it is to position.

How long does it take to become a mammography tech?

Mammography Certification Number. The Mammography Certification Number is assigned to a provider certified to perform a mammography and is required on all mammography claims.

What are the requirements for MQSA?

Do You Need a Degree to Be a Mammogram Tech? The minimum degree requirement for a mammographer is an associate degree. Youll start with at least two years of x-ray school training to qualify as a fully licensed radiologic technologist, the general term for a professional who carries out diagnostic imaging.

What are the training requirements for MQSA mammography?

Initial training requirement documentation. Certificate of 15 CE credits completion. A document containing information about you having completed the continuing experience requirement for the MQSA. Therefore, you should have experience with performing a minimum of 200 mammograms during the given time.

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