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Applications and Forms - X-Ray Registration and Services


Table of Contents


X-Ray Machines

X-Ray Machines Applications and Forms
Document Number Title
LRS-35 Additional Information for Accelerator Registration, Includes Shielding Form (PDF, 21KB)
RC 17-R Request for Registration Termination (PDF, 24KB)
RC 18-R Radiation Machine Transfer/Disposal Form (PDF, 16KB)
RC 42-3 Radiation Safety Officer (RSO) Information for Registration (PDF, 301KB)
RC 42-4 Industrial Radiation Safety Officer (RSO) Form (PDF, 558KB)
RC 42-5 Industrial Radiography (IR/NDT) Radiation Safety Officer (RSO) Form (PDF, 40KB)
RC 204 Schedule of Biennial Fees for Registration for Radiation Machines (PDF, 25KB)
RC 226-1 Business Information Form - Registration (PDF, 24KB)
RC 226-2 Registration Application for Users of Radiation Machines in Healing Arts, Veterinary Medicine and Academic Facilities (PDF, 27KB)
RC 226-3 Registration Application for Industrial Radiation Machines (PDF, 32KB)

Instructions for RC 226-3 Registration Application (PDF, 508KB)
RC 226-5 Registration Application for Radiation Machine Services (PDF, 320KB)

Instructions for RC 226-5 Registration Application (PDF, 453KB)
RC 226-8 Excerpt from 25 Texas Administrative Code (TAC) Section 289.226(g). Mobile Service Operation (PDF, 41KB)
RC 226-9 Authorization for Self-Referred CT Coronary Calcium Screening (PDF, 48KB)
RC 226-10 Healing Arts Screening Requirements for Osteoporosis (PDF, 18KB)
RC 226-11 Authorization for Self-Referred Low Dosage CT Lung Cancer Screening (PDF, 35KB)

Equipment Performance Evaluation

Please contact Jerry Cogburn via email or telephone at (512) 834-6770 ext. 2037, about any other inspection forms.

Equipment Performance Evaluation Forms
Document Number Title
EPEDent-1 Equipment Performance Evaluation, Dental Radiographic Unit (PDF, 90KB)
EPERad-1 Equipment Performance Evaluation, Radiographic Unit (PDF, 92KB)
EPEVet-1 Veterinary Equipment Performance Evaluation (PDF, 72KB)


Notice to Employees

Notice to Employees
Document Number Title
RC 203-1 Notice to Employees (PDF, 10KB)
RC 232-1 Notice to Employees (Dentists Only) (PDF, 9KB)
RC 233-2 Notice to Employees (Vets Only) (PDF, 64KB)

Licensing Reciprocity

Licensing Reciprocity Forms
Document Number Title
RC 252-1 Business Information Form - License (PDF, 54KB)
RC 252-3 Notice of Intent to Work in Texas Under Reciprocity (PDF, 27KB)
Submit by FAX only. Please review the “Sensitive Information” notice on the form
None Notice of Intent to Work in Texas Under Reciprocity - Non Industrial-Radiography (PDF, 106KB)
None Notice of Intent to Work in Texas Under Reciprocity - X-Ray Services (PDF, 99KB)
Last updated May 9, 2017