Forms 

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

RAM Medical Application/Renewal Forms

On the pdf forms below, fill in the information online, print it out, sign where appropriate and mail back to us at the address below with any fees that are due.

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