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Application form for license to operate a medical x ray facility 2021-2026
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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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