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Radiologic Health Branch (RHB)

Radiologic Technology and Nuclear Medicine Technology

The information you provide to the RHB may be disclosable under the California Public Records Act (PRA). In response to PRA requests, RHB may release the address of record for Radiologic Technologists, X-ray Technicians, Nuclear Medicine Technologists, and Certified Supervisor and Operators. If you wish to provide RHB with an alternate address that will be released to the public release upon request, please submit form CDPH 8391.

Applications and FAQS

RHB's application forms (below) are categorized as follows:

Radiologic Technologist (RT) Forms
Limited Permit X-ray Technician (XT) Forms
Licentiate Forms (i.e. MD, DO, DC, DPM, PA)
Nuclear Medicine Technologist (NMT) Forms
Miscellaneous Forms: Change of Name/Address - RT, XT, NMT, & Licentiate.

IMPORTANT NOTE: If you did not receive your renewal notice, use the "Special Renewal Application" as found in the applicable category below.

General Information or Links:

Radiologic Technologists (RT) Forms

CDPH 8200 (PDF) - Radiologic Technology Certificate Application (Diagnostic & Therapeutic). [DO NOT USE FOR CERTIFICATE RENEWAL]
CDPH 8200 M (PDF) - Mammographic Radiologic Technology Certificate Application [DO NOT USE FOR CERTIFICATE RENEWAL]
Special Renewal Application forms for CRTs only:

CDPH 8200 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8200 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

CDPH 8218 (PDF) - Radiologic Technologist Fluoroscopy Permit Application [DO NOT USE FOR PERMIT RENEWAL]
CDPH 8241 (PDF) - PET/CT On-The-Job (OJT) Registration Application [DO NOT USE FOR RENEWAL PURPOSES]
RHB Reinstatement Fee Schedule - X-ray Certificates/Permits (PDF)

Limited Permit X-ray Technician (XT) Forms

CDPH 8232 (PDF) - XT Application [DO NOT USE FOR PERMIT RENEWAL]
CDPH 8232 DEXA (PDF) - Dual Energy X-ray Absorptiometry (DEXA) Permit Application [DO NOT USE FOR PERMIT RENEWAL]
Special Renewal Application forms - XT - DEXA only.
- CDPH 8232 DEXA SRA II (PDF) - ONLY USE IF YOUR PERMIT EXPIRES FROM 1/01/15 to 8/31/17.
- CDPH 8232 DEXA SRA III (PDF) - ONLY USE IF YOUR PERMIT EXPIRES AFTER 8/31/17.
Special Renewal Application - XT (Excluding DEXA)

CDPH 8232 SRA II (PDF) - ONLY USE IF YOUR PERMIT EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8232 SRA III (PDF) - ONLY USE IF YOUR PERMIT EXPIRES AFTER 8/31/17.

CDPH 9054 (PDF) - XT Digital Authorization Application
RHB Reinstatement Fee Schedule - X-ray Certificates/Permits (PDF )

Licentiate Forms (MD, DO, DC, DPM, PA)

Special Renewal Application forms for Physician Assistant Fluoroscopy Permits:

CDPH 8217 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8217 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

CDPH 8230 (PDF) - California Licentiate Supervisor & Operator Permits [DO NOT USE FOR PERMIT RENEWAL]
CDPH 8231 (PDF) - California Radiology S&O Certificate. (For Radiologists ONLY) [DO NOT USE FOR CERTIFICATE RENEWAL]
Special Renewal Application forms -- S&O Certificate or Permit.

CDPH 8238 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8238 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

CDPH 8711 (PDF) - California Licentiate X-ray Bone Densitometry S&O Permit.
RHB Reinstatement Fee Schedule - X-ray Certificates/Permits (PDF )

Nuclear Medicine Technologists (NMT) Forms

CDPH 8435 (PDF) - Nuclear Medicine Technology Certificate Application [DO NOT USE FOR PERMIT RENEWAL]
Special Renewal Application forms for Certified Technologist, Nuclear Medicine (CTNM) only:

CDPH 8435 SRA (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES BEFORE 1/01/15.
CDPH 8435 SRA II (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES FROM 1/01/15 to 8/31/17.
CDPH 8435 SRA III (PDF) - ONLY USE IF YOUR CERTIFICATE EXPIRES AFTER 8/31/17.

RHB Reinstatement Fee Schedule - X-ray Certificates/Permits (PDF )

Miscellaneous Forms

CDPH 8391 (PDF) - Change of Name or Address Form - RT, XT, NMT, & Licentiates
RHB Reinstatement Fee Schedule - X-ray Certificates/Permits (PDF )

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