Authorization radiological procedures 2026

1. Click ‘Get Form’ to open the authorization radiological procedures form in the editor.
2. Begin by entering your personal information. Fill in your last name, first name, and middle name in the designated fields.
3. Provide your complete address, including street, city, state, and zip code. Ensure accuracy for correspondence.
4. Input your Social Security Number in the specified format (XXX-XX-XXXX) and include your date of birth (MM/DD/YYYY).
5. Enter your phone number with area code and provide a valid email address for communication purposes.
6. Indicate the examination date when you completed the Radiation Health & Safety examination.
7. Attach a check or money order for $75.00 as instructed. Remember not to send cash and ensure it is payable to 'Commonwealth of PA'.

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