Last updated: 4/11/2025
Application For Mammography Machine Certification {CDPH 8624}
Start Your Free Trial $ 17.99What you get:
- Instant access to fillable Microsoft Word or PDF forms.
- Minimize the risk of using outdated forms and eliminate rejected fillings.
- Largest forms database in the USA with more than 80,000 federal, state and agency forms.
- Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
- Trusted by 1,000s of Attorneys and Legal Professionals
Description
CDPH 8624 - APPLICATION FOR MAMMOGRAPHY MACHINE CERTIFICATION. Use this form when your facility, business, or practice possesses one or more radiation machines used for mammography, as defined by the relevant regulations and you wish to notify the California Department of Public Health, Radiologic Health Branch (CDPH-RHB) of your new mammography facility, renew/reinstate a mammography machine certificate, change your existing facility information, add a new machine, or other reasons pertaining to mammography machine certification. It includes various sections that gather information on the facility's status, personnel, equipment, and system evaluation. The application helps ensure that the facility meets all necessary regulations and standards for operating mammography machines. It asks for details about the facility type, changes in ownership or address, and updates on personnel involved in mammography. It also requests information on the machines in use, including their make, model, and serial numbers, along with details of any mobile machines. It requires submission of a report from a medical physicist evaluating the mammography system, and a certification section where the applicant declares that the provided information is accurate. Title 17 California Code of Regulations, Division 1, Chapter 5, Subchapter 4, Group 3, Article 4.5, Requirements for the Use of X-Ray in Mammography. www.FormsWorkflow.com
