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    The Radiation Control Program (RCP) is within the
    Division for Regulatory Services
    P. O. Box 149347
    Austin, TX 78714-9347
    512-834-6770


    Link to Texas.gov
    texasgovbox

    Link to Texas.gov

    Government at Your Fingertips
     

    Contact the Web Director


    External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may not be accessible to people with disabilities.


Applications and Forms - Radiation Control Program

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All files are offered in PDF format, which can be read by the Adobe Acrobat Reader. Radiation Control is working towards providing forms in Microsoft Word, also. If a form is available in Word, it is posted below.

You will need to download the Adobe Acrobat Reader to access files on this Web site. Some files require you to install the newest version of the Adobe Acrobat Reader. 


MORE INDUSTRIAL RADIOGRAPHER FORMS AND INFORMATION MAY BE FOUND ON THE INDUSTRIAL RADIOGRAPHY PAGE.


Links to Applications and Forms

LICENSE APPLICATIONS AND FORMS

App/Form Number Title PDF File WORD File
RC 203-1 Notice to Employees PDF   10 KB n/a
RC 251-1 Acknowledgement to Use the General License for In Vitro Clinical or Laboratory Testing PDF   43KB WORD   72KB
RC 251-2 General License Acknowledgement of Devices Containing Radioactive Material PDF   87KB WORD    85KB  
CI-40 General License Acknowledgement Self-Evaluation Form PDF   103KB WORD   147KB
RC 252-1 Business Information Form - License PDF   74KB WORD   62KB
RC 252-2 Radioactive Material License PDF   321KB WORD   118KB
RC 252-2a Radioactive Material License -- Medical Uses PDF   28KB WORD   130KB
RC 252-2b Preceptor Statement for License Application -- Medical PDF   28KB WORD   128KB
RC 252-3 Notice of Intent to Work in Texas Under Reciprocity PDF   27KB WORD   58KB

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REGISTRATION APPLICATIONS AND FORMS

App/Form Number Title PDF Files WORD File

RC 203-1

BRC 232-1

BRC 233-2

Notice to Employees

Notice to Employees (Dentists only)

Notice to Employees (Vets only)

PDF   10 KB

PDF   9KB

PDF   64KB

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RC 204 Schedule of Biennial Fees for Medical for Educational/Healing Arts Certificate of Registration for Radiation Machines PDF    25 KB n/a
RC 226-1 Business Information Form - Registration PDF   24KB n/a
RC 226-2 Registration Application for Users of Radiation Machines in Healing Arts, Veterinary Medicine and Academic Facilities PDF   27KB

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RC 226-3

 

Registration Application for Industrial Radiation Machines

Instructions

PDF   32KB

PDF   17KB

WORD   74KB

RC226-5

 

Radiation Machine Services Application

Instructions

PDF   320KB

PDF   67KB

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RC 226-8 Registration of Mobile Services Used in the Healing Arts and Veterinary Medicine PDF   41KB

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RC 226-9     Healing Arts Screening Requirements for Atherosclerosis PDF   18KB WORD   55KB
RC 226-10 Healing Arts Screening Requirements for Osteoporosis PDF   18KB WORD   47KB
RC 252-3 Notice of Intent to Work in Texas Under Reciprocity PDF   27KB WORD   58KB
RC 301-2 Application for Lasers PDF   23KB WORD   54KB
RC 301-3 Written Notice for Laser Light Show in Texas PDF   11KB n/a
RC 301-4 Registration Application for Laser Services PDF   35KB WORD   74KB
RC 302-2     Application for Laser Hair Removal Certifying Entities PDF   264KB n/a
RC 302-3 Registration Application for Laser Hair Removal Training Programs PDF   470KB n/a
RC 302-4 Registration Application for Laser Hair Removal Facility PDF   94KB WORD   95KB
RC 302-5 Registration Application for Laser Hair Removal Appretice in Training PDF   30KB WORD   70KB
RC 302-6 Registration Application for Laser Hair Removal Technician PDF   41KB WORD   116KB
RC 302-7 Registration Application for Laser Hair Removal Senior Technician PDF   52KB WORD   163KB
RC 302-8 Registration Application for Laser Hair Removal Professional PDF   52KB WORD   159KB
RC-17-R Termination of a Certificate of Registration PDF   24KB n/a
RC-17-L  Termination of Laser Registration PDF   24KB WORD   44KB
RC 18-L  Laser Transfer/Disposal Form PDF   16KB WORD   43KB
RC 18-R Radiation Machine Transfer/Disposal Form PDF   16KB n/a
LRS-35 Additional Information for Accelerator Registration, Includes Shielding Form PDF   21KB WORD   32KB
RC 42-L Laser Safety Officer (LSO) Information PDF   32KB WORD   53KB
RC 42-3 RSO Information for Registration PDF   24KB n/a

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MAMMOGRAPHY APPLICATIONS AND FORMS

Please contact Jo Turkette via email about other Mammography forms or telephone 512-834-6688

App/Form Number Title PDF Files
RC 230-1  Application for Mammography Certification - New Facility or Renewal  PDF   137KB
RC 230-2 Amendment Application for Mammography Certification PDF   131KB
RC 230-3 Application for Interventional Breast Radiography - New Facility or Renewal PDF   73KB
RC 230-4 Amendment Application for Interventional Breast Radiography  PDF   77KB
RC 17-M Termination of Certification of Mammography Systems PDF   17KB
RC 18-M  Mammography Machine Transfer/Disposal Form PDF   17KB

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EQUIPMENT PERFORMANCE EVALUATION FORMS

Please contact Jerry Cogburn via email or telephone at 512-834-6770 extension 2037, about any other inspection forms

App/Form Number Title PDF Files WORD File
EPEDent-1 Equipment Performance Evaluation, Dental Radiographic Unit PDF   90KB WORD   96KB
EPEVet-1 Veterinary Equipment Performance Evaluation PDF   72KB WORD   45KB
EPERad-1 Equipment Performance Evaluation, Radiographic Unit PDF   92KB WORD   97KB

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Back to the Top - Radiation Control Home - Search - Site Map - Links - Contact Us - Texas Department of State Health Services
Division for Regulatory Services - P. O. Box 149347 - Austin, Texas 78714-9347 - (512) 834-6770

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Last updated June 25, 2014