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Click ‘Get Form’ to open it in the editor.
Begin by entering the Machine Number and Facility Registration Number at the top of the form. Ensure these details are accurate for proper identification.
Fill in the Tube I.D., Facility Name, and Inspector License No. These fields are crucial for compliance and tracking purposes.
Indicate the Manufacturer and Model of your equipment, specifying if it is mobile. Enter the maximum kVp and mA values as well as the date manufactured.
Complete the sections regarding Federal Certification Standards by selecting 'Yes' or 'No' based on your equipment's compliance.
Proceed to fill out all relevant modes available for your fluoroscopic system, ensuring you check all applicable options.
Review each requirement listed under 'Requirements for Fluoroscopic Procedures and Equipment', marking Pass (P), Fail (F), or Not Applicable (N/A) as necessary.

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Why would a doctor order a fluoroscopy?

Fluoroscopy is commonly used to: Check how the stomach and intestines are working. Check if food is being properly swallowed and how the muscles of the mouth and throat are working. Guide medical procedures to place catheters, stents, or other devices inside the body, such as in the heart or blood vessels.

Who performs a fluoroscopy?

When used by highly trained, board certified radiologists and radiologic technologists, fluoroscopic examinations provide substantial diagnostic benefit to patients and is instrumental in guiding treatment plans.

What is fluoroscopic imaging?

Description. Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. During a fluoroscopy procedure, an X-ray beam is passed through the body.