Application for X-Ray Facilities

What this is For:

Application for X-Ray Facilities

Where to File:

BUREAU OF HEALTH DEVICES AND TECHNOLOGY

(former name: RADIATION HEALTH SERVICE)

San Lazaro Cpd., Rizal Avenue

Sta. Cruz, Manila, Philippines 1003

Telefax No. 711-6016 or 743-8301 loc. 3403 to 3406

How to File:

Three (3) copies of properly filled-up application form including the original copy must be submitted.

Page 1 of the application form must be signed by the following:

a. chief radiologist

b. chief radiologic/x-ray technologist

c. radiation safety officer who may be the radiologist or the radiologic/x-ray technologist

d. owner of the facility

All questions in the application form must be properly answered.

The duly accomplished application form must be submitted together with

a. Certificate of Training in Radiology, PRC ID & Contract of Agreement between the applicant and the radiologist

b. Certificate of PRC registration, PRC ID & Contract of Agreement between the applicant and the radiologic/x-ray technologist/s

c. Copy of the latest x-ray license certificate

All deficiencies noted by the Bureau of Health Devices and Technology (former name: Radiation Health Service) health physics team in the latest radiation protection survey and evaluation report must be complied with. Proof of compliance (pictures, receipts, charts, logbooks, etc.) and a duly notarized certificate of compliance signed by an authorized personnel of the facility must be submitted together with the application form.

Correct amount of license application fee, as indicated in the attached Schedule of Fees, must be paid. Postal money order must be made payable to the Bureau of Health Devices, Department of Health.

SCHEDULE OF FEES (Adjusted as per A.O. # 29,s.2000)

MA range of Initial Renewal

100 mA and less P 800.00 P400.00

101 mA up to 300 mA 1,100.00 550.00

301 mA up to 500 mA 1,400.00 700.00

501 mA up to 700 mA 1,700.00 850.00

Greater than 700 mA 2,000.00 1,000.00

Other Documentary Requirements:

Duly accomplished license application form with corresponding license fee

Contract of employment of radiologist and radiologic/x-ray technologist

Certificate of training of doctor if he/she is not a fellow of Philippine College of Radiology

Photocopy of PCR certificate and PRC license of radiologist (if diplomate or fellow)

Photocopy of PRC license of radiologic/x-ray technologist

Certificate of training in radiation protection of radiologic/x-ray technologist if he/she acts as Radiation Safety Officer

Photocopy of business/mayors permit and SEC registration certificate

checklist

list of documents to be submitted