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Applications and Forms - Mammography Programs

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

Mammography Applications and Forms
Document Number Title
RC 17-M Termination of Certification of Mammography Systems (PDF, 17KB)
RC 18-M Mammography Machine Transfer/Disposal Form (PDF, 17KB)
RC 42-3 Radiation Safety Officer Information for Registration (PDF, 301KB)
RC 204 Schedule of Biennial Fees for Registration for Radiation Machines (PDF, 25KB)
RC 226-1 Business Information Form - Registration (PDF, 24KB)
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 230-43 Lead interpreting Physician (LIP) Form (PDF, 230KB)
RC 230 234 - 1 New Facility Invoice (PDF, 606KB)
None Acceptable Documents for Interpreting Physicians (PDF, 145KB)
None Acceptable Documents for Medical Physicists (PDF, 199KB)
None Acceptable Documents for Radiologic Technologists (PDF, 126KB)

Notice to Employees

Notice to Employees
Document Number Title
RC 203-1 Notice to Employees (PDF, 10KB)

Last updated January 25, 2017