RADIATION CONTROL PROGRAM
Amendment to Add a Physician to a License
A request to add a physician to a license must be directed by either the radiation safety officer or executive management. A managing partner of a private physician association would constitute executive management.
A signed, written statement from each physician to be added to the license must be submitted. The statement must certify their familiarity with and agreement to abide by the statements, representations and procedures and/or correspondence submitted for the issuance or amendment of the license.
To confirm a physician’s credentials, submit documentation as described in one of following:
Reference another Radioactive Material license, issued by the Texas Department of Health, on which the physician wanting to be added, is or has been listed as an authorized user within the last 7 years (note that requested use(s) beyond those described on the referenced license will require documentation of additional training and experience and a signed preceptor attestation as described in rule); or
Provide a signed preceptor statement RC Form 252-2b
from a preceptor authorized user which validates the physician’s training, to include dates, and the level of experience the physician has with radioactive material which is commensurate with the requirements of Title 25 Texas Administrative code §289.256;or
Provide a copy of an acceptable board certification issued within the last 7 years (include a signed preceptor attestation); or
Provide a dated copy of a specific Radioactive Material license issued from the Nuclear Regulatory Commission, an agreement state or any licensing state which identifies the physician and specifies their use authorizations. The license must be dated within the immediate 7 years prior to application. Provide documentation of additional training and experience (to include a preceptor attestation) if the individual is requesting use(s) not authorized on the out-of-state license.
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Division for Regulatory Services - P. O. Box 149347 - Austin, Texas 78714-9347 - (512) 834-6770