radiologic health branch

Medical Licensing Unit - Forms & Guides

Please Note: Title 17, California Code of Regulations, section 30195(a) (17 CCR 30195(a)) incorporates by reference the 2021 edition of Title 10, Code of Federal Regulations, Part 35 (Part 35)(PDF). Please see 17 CCR 30195(a) for exceptions.

NOTE: To use the RH 2000 form, please download the document and open in Adobe Acrobat.

RH 313A (RSO) (PDF) - Interactive Training and Experience Form for Radiation Safety Officer.
RH 313A (AU) (PDF) - Interactive Training and Experience Form for Authorized User
RH 313A (AMP) (PDF) - Interactive Training and Experience Form for Authorized Medical Physicist
RH 313A (ANP) (PDF) - Interactive Training and Experience Form for Authorized Nuclear Pharmacist

CDPH 8243 MRM (PDF) - Duties and Responsibilities of the RSO And Delegation of Authority Form for Medical Use
CDPH 8243 MRMA (PDF) - Duties and Responsibilities of the RSO And Delegation of Authority Form for Medical and Academic Use
CDPH 8243 MRA (PDF) - Duties and Responsibilities of the RSO And Delegation of Authority Form for Academic Use
CDPH 8243 MRP (PDF) - Duties and Responsibilities of the RSO And Delegation of Authority Form for Pharmacy Use
CDPH 8243 IR5 (PDF) - Duties and Responsibilities of the RSO for Veterinary Use
CDPH 8243 IA5 (PDF)- Duties and Responsibilities of the ARSO for Veterinary Use
CDPH 8243 IR1 (PDF) - Delegation of Authority for the RSO for Veterinary Use
CDPH 8243 IA1 (PDF) - Delegation of Authority for the ARSO for Veterinary Use

Specialty Board(s) Certification recognized by the U.S. Nuclear Regulatory Commission under 10 CFR Part 35
Part 35 Questions and Answers. Some of the questions and answers were developed using a version or sections of Part 35 that are not adopted by the State of California and may not apply.
HDR Guide (PDF) for authorization to use high dose remote afterloaders by medical licensees.
NRC Emerging Technologies
Guidance for Decay in Storage Method of Waste Disposal (PDF)
Irradiators-Small (PDF) - Information for small irradiator licensees
Gas Chromatographs (PDF) - Guidance for Gas Chromatographs (i.e., Ni-63, H-3)
X-ray Fluorescence (PDF) - Guidance for X-ray fluorescence devices (XRFs)
Krypton-85 (PDF). Guidance for Krypton-85 leak test systems.
CDPH Veterinary Licensing Guidance (PDF)
U.S. Nuclear Regulatory Commission (NRC) Guidance:

Ownership Change - Sample (DOCX) - Sample letter for requesting a change of ownership. (Note: If you are having difficulty accessing this document, please contact CDPH at RHBGLLicensingInfo@cdph.ca.gov to request this information in an alternate format.)

CDPH 5314 Notice (PDF) - Information about terminating a License.
CDPH 5314 (PDF) - Certificate of Disposition of Materials.
Guidance for Termination and Decommission for Sealed Source Use only (PDF)
Information Notice 18-02 (PDF) - Requirement for “Decommissioning Service Providers” to Have an Active Radioactive Materials License.
Future Posting - Guidance for Termination or Decommissioning for Licensees Using Short Half-life (≤ 120 days) Radioactive Material