Forms 

Forms: Fixed Gauge |  Industrial Radiography  | Medical | Portable Gauge

RAM Medical Application/Renewal Forms

All documents are in PDF format unless noted otherwise.

Downloads
Radioactive Material License Application
Licensing Guide
Arkansas’ Standard for Radiological Protection for Release of Patient Administered I-131 Sodium Iodide
Medical Licensing Forms and Appendices Complete - ZIP file

 
Appendices

Appendix A - ALARA Program

Appendix B - Medical Use Training and Experience

Appendix B-MedFormA( AMP) - Authorized Medical Physicist Training and Experience and Preceptor Attestation 
Appendix B-MedFormA (ANP) - Authorized Nuclear Pharmacist Training and Experience and Preceptor Attestation
Appendix B-MedFormA( AUD) - Authorized User Training and Experience and Preceptor Attestation (for uses defined under RH-8500, RH-8530, and RH-8620)
Appendix B-MedFormA( AUS) - Authorized User Training and Experience and Preceptor Attestation(for uses defined under RH-8600 and RH-8630)
Appendix B-MedFormA (AUT) - Authorized User Training and Experience and Preceptor Attestation (for uses defined under RH-8550)
Appendix B-MedFormA( RSO) - Radiation Officer Training and Preceptor Attestation
Appendix C1 - Radiation Safety Officer’s Model Delegation of Authority
Appendix C2 - Duties and Responsibilities of the Radiation Safety Officer
Appendix D - Radiation Safety Training Program
Appendix E - Med  Leak Test of Sealed Radioactive Sources
Appendix F - Radiation Detection Instruments
Appendix G - Calibration of Radiation Detection Instruments
Appendix H - Personnel Monitoring
Appendix I - Dose to Members of the Public
Appendix J - Facilities and Equipment
Appendix K - Radiation Survey Program
Appendix L - Ordering, Receiving, Opening and Shipping Packages Containing Radioactive Material
Appendix M - Disposal or Transfer of Radioactive Material
Appendix N - Increased Controls for Licensees that Possess Sources Containing Radioactive Material Quantities of Concern
Appendix O - Transportation Regulations
Appendix P  Checklist
Appendix P - Radiation Safety Program and Operating Procedures
Appendix P1 - Safe Use of Unsealed Radioactive Material
Appendix P2 - Procedures for Administrations when a Written Directive is Required
Appendix P3 - Release of Patients or Human Research Subjects
Appendix P4 - Records of Dosages and Use of Brachytherapy  Source
Appendix P5 - Safety Procedures for Treatments when Patients are Hospitalized

Appendix P6 - Sealed Source Inventory

Appendix P7 - Installation, Maintenance, Repair and Inspection of Therapy Devices Containing Sealed Sources
Appendix P8 - Minimization of Contamination
Appendix P9- Mobile Medical Service
Appendix Q - Checklist
Appendix Q - Emergency Procedures
Appendix Q1 - Safety Procedures and  Instructions
Appendix Q2 - Spill Procedures
Appendix Q3 - Emergency Surgery of Patients Who Have Received Therapeutic Amounts of Radioactive Material
Appendix Q4 - Autopsy of Patients Who Have Received Therapeutic Amounts of Radioactive Material
Appendix R -  Administrative Procedures
Appendix S - Annual Radiation Safety Program Audit
Appendix S1 - Annual Radiation Safety Program Audit Form

OfficeAddressPhoneFax
Radioactive Materials 4815 W. Markham Street, Slot 30
Little Rock, AR 72205
501-661-2173501-661-2849