Fda x ray application form: Fill out & sign online

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How to use or fill out application form for license to operate a medical x ray facility 2021

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Click ‘Get Form’ to open it in the editor.
Begin with Section I: General Information. Fill in the name and address of your facility, along with contact numbers. Ensure all details are accurate and legible.
Proceed to list the personnel working in the facility under Section II. Include names, qualifications, and PRC ID numbers for each individual, ensuring you mark their roles correctly.
In Section III, declare the veracity of the information provided by signing and dating the declaration. This step is crucial for compliance.
Complete Section IV by detailing equipment specifications. List all x-ray machines, including manufacturer names, models, serial numbers, and maximum kVp/mA ratings.
For Sections V and VI, provide information on other radiologists and medical practitioners at your facility. Use separate sheets if necessary for additional staff.
Finally, select your X-ray Service Category in Section VII by ticking the appropriate boxes that reflect your facility's capabilities.

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medical x ray facility license application form

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