RMS - Licenseing for Private Practice Medical Facilities


Private Practice Nuclear Medicine, Brachytherapy and/or HDR

This information is being provided for licensees who are applying for renewal or a new license for private practice uses of radioactive materials, including brachytherapy and HDR applications.

Documents are usually available in both Word97 () and PDF () formats. The available format is listed in the right-most columns of the table below. The Word files are locked and only certain regions of certain forms are editable. Save the form to your network or local drive and edit as necessary. Make sure that the "Show/Hide" (¶ on the tool bar) setting is set to "Show" in order to use the forms in Word.

NOTE: The application and/or amendment forms MUST be signed as indicated in the licensing guide. DRP has no ability to accept electronic signatures at this time. Should this policy change, the website will be updated for this provision.

To find the status of a licensing action, contact Nick Driver at (919) 571-4141

Description of Guide(s)/Form(s)

Licensing Guide for Private Practice Nuclear Medicine
Licensing Guide for High Dose Rate Afterloaders (HDR)
Licensing Guide for Brachytherapy
Licensing Guide for Mobile Nuclear Medicine Services
Memorandum to All Licensees
Application for Radioactive Materials License
Amendment Form
Guidance on Adding Board Certified Physician Authorized Users
Preceptor Statement (Supplement A) for Medical Licenses
NRC Regulatory Guide 8.39 "Release of Patients Administered Radioactive Materials"
Medical Event Reporting Form (EFFECTIVE March 01, 2008)
Dose to an Embryo/Fetus or Nursing Child Reporting Form (EFFECTIVE March 01, 2008)