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The CDPH 8218 form is an essential document for those seeking a Radiologic Technologist Fluoroscopy Permit in California. This application, managed by the California Department of Public Health's Radiologic Health Branch, requires applicants to provide personal information, including their full legal name, date of birth, and social security number. The form outlines key eligibility requirements, such as possessing a current California Diagnostic Radiologic Technology Certificate or a completed application for a certificate with an American Registry of Radiologic Technologists (ARRT) certification in Radiography. To proceed with the application, a non-refundable fee of $88.00 must be submitted, alongside supporting documents that demonstrate appropriate educational qualifications. After the application is sent, applicants can expect to receive a notification letter within 30 days, detailing whether their application has been accepted or if further information is needed. It is crucial to complete this form accurately, as failure to use the correct legal name or to include required documentation may result in delays or denial of the permit. Understanding the importance of this permit, particularly in the context of working with X-rays, underscores the seriousness of the process. Navigating this application can feel daunting, but complying with these necessary steps helps ensure that individuals can safely engage in radiologic practices within the state.

Cdph 8218 Example

State of California—Health and Human Services Agency

California Department of Public Health

 

Radiologic Health Branch

Radiologic Technologist Fluoroscopy Permit Application

(Failure to use your full legal name may result in entrance into the examination being denied.)

Last Name (Please Print)

First Name

Middle Name

 

 

 

 

 

Date of Birth

Social Security Number

Phone Number

 

 

 

 

Mailing Address

 

E-mail Address

 

 

 

 

 

City

 

State

 

Zip Code

 

 

 

 

 

ATTENTION! You must provide one of the following requirements for your application to be considered:

Current California Diagnostic Radiologic Technology Certificate Number: Or

A completed application for a Diagnostic Radiologic Technology Certificate with your American Registry of Radiologic Technologists (ARRT) Certificate in Radiography.

Pursuant to the authority found in Section 114870 of the California Health and Safety Code and as required by Section 17520 of the California Family Code, providing the social security number is mandatory. The social security number will be used for purposes of identification. The information on this form may be provided to federal, state, or local agencies for law enforcement purposes. This information may also be provided to the American Registry of Radiologic Technologists for examination purposes. For information or access to your records, contact the Registration and Certification Support Unit at the California Department of Public Health, Radiologic Health Branch (CDPH-RHB), MS 7610, P.O. Box 997414, Sacramento, CA 95899-7414, (916) 327-5106.

HOW DO I OBTAIN A CALIFORNIA RADIOLOGIC TECHNOLOGIST FLUOROSCOPY PERMIT?

You must submit this application along with the following:

The non-refundable application fee of $88.00 in the form of a check (e.g., personal, cashier’s, or certified check) or money order made payable to CDPH-RHB, and one of the following:

A copy of your graduation diploma or certificate from a CDPH-RHB approved radiologic technologist fluoroscopy school; or

Documentation that you graduated from a diagnostic radiologic technology program accredited by the Joint Review Committee on Education in Radiologic Technology (JRCERT) and passed the American Registry of Radiologic Technologists (ARRT) radiography examination; or

Documentation that you are certified by ARRT in radiography and a current ARRT registrant.

HOW WILL I BE NOTIFIED ABOUT THE STATUS OF MY APPLICATION?

Within 30 calendar days of receipt of your application, CDPH-RHB will mail you a notification letter. The notification letter will inform you of one of the following:

That your application is acceptable and what examination you must pass within one calendar year in order to obtain the certificate/permit, and instructions on how to submit payment of the non-refundable examination fee; or

That your application is not accepted for filing and what specific information, documentation or fee you must submit within 30 calendar days in order for CDPH-RHB to consider the application acceptable.

CDPH 8218 (1/15)

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State of California—Health and Human Services Agency

California Department of Public Health

 

Radiologic Health Branch

Radiologic Technologist Fluoroscopy Permit Application

(Failure to use your full legal name may result in entrance into the examination being denied.)

Last Name (Please Print)

First Name

Middle Name

HOW DO I SUBMIT MY APPLICATION?

Please mail this application, all supporting documents, and payment for the non-refundable application fee of $88.00 to:

California Department of Public Health

Radiologic Health Branch, MS 7610 Accounts Receivable and Cashiering Unit P.O. Box 997414

Sacramento, CA 95899-7414

I certify that the information provided with this application is true and correct. I understand that the California Department of Public Health may revoke certificates or permits that are procured by fraud, misrepresentation, or mistake, or for the nonpayment of fees. Further, I am aware that it is unlawful to use X-rays on human beings in this state unless I have been granted a certificate or permit pursuant to the Radiologic Technology Act, am acting within the scope of that certificate or permit, and am acting under the supervision of a licentiate of the healing arts who is a certified supervisor or operator.

Signature

Date

CDPH 8218 (1/15)

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Form Characteristics

Fact Name Details
Governing Law This form is governed by Section 114870 of the California Health and Safety Code and Section 17520 of the California Family Code.
Application Fee A non-refundable application fee of $88.00 is required for processing.
Submission Methods Applications must be mailed to the California Department of Public Health, specifically the Radiologic Health Branch.
Identification Requirement Providing a Social Security number is mandatory for identification purposes.
Notification Timeline Applicants will receive notification within 30 calendar days regarding the status of their application.
Permitting Conditions X-ray usage is illegal in California without a valid certificate or permit and supervision by a licensed professional.
Contact Information For inquiries, contact the Registration and Certification Support Unit at (916) 327-5106.

Guidelines on Utilizing Cdph 8218

Submitting the Cdph 8218 form is an important step in obtaining your Radiologic Technologist Fluoroscopy Permit. To ensure a smooth application process, it's crucial to accurately fill out the form and include all necessary documentation. Follow these steps carefully to avoid any setbacks.

  1. Gather your personal information: Collect your last name, first name, middle name, date of birth, social security number, phone number, mailing address, e-mail address, city, state, and zip code.
  2. Provide identification: Include your current California Diagnostic Radiologic Technology Certificate Number or complete an application for a Diagnostic Radiologic Technology Certificate with your ARRT Certificate in Radiography.
  3. Prepare your payment: Write a check (personal, cashier’s, or certified) or obtain a money order for the non-refundable application fee of $88. Make it payable to CDPH-RHB.
  4. Attach supporting documents: Include either a copy of your graduation diploma or certificate from an approved radiologic technologist fluoroscopy school, or documentation that you graduated from an accredited diagnostic radiologic technology program and passed the ARRT radiography examination, or proof of your ARRT certification in radiography.
  5. Sign and date the application: At the bottom of the form, certify that the information provided is accurate and acknowledge the conditions regarding fraud, misrepresentation, and the use of X-rays.
  6. Mail your application: Send the completed form, all supporting documents, and your payment to:
    • California Department of Public Health
    • Radiologic Health Branch, MS 7610
    • Accounts Receivable and Cashiering Unit
    • P.O. Box 997414
    • Sacramento, CA 95899-7414

After submitting your application, you will receive a notification letter within 30 days about its status. Stay vigilant and be prepared to provide any additional information if requested, to keep the process moving forward smoothly.

What You Should Know About This Form

What is the CDPH 8218 form?

The CDPH 8218 form is an application for the Radiologic Technologist Fluoroscopy Permit provided by the California Department of Public Health. It is specifically designed for applicants who wish to use fluoroscopy equipment as part of their radiologic technology practice in California. Completing this form is the first step to obtaining permission to operate fluoroscopy devices.

What are the requirements for submitting the CDPH 8218 form?

To submit the CDPH 8218 form, applicants must provide several key pieces of information, including their full legal name, date of birth, Social Security number, contact information, and payment. Additionally, they must include documentation confirming graduation from an approved school or program in radiologic technology, along with a non-refundable application fee of $88.00.

How do I pay the application fee?

The application fee of $88.00 can be paid via a personal check, cashier’s check, certified check, or money order. Make sure that the payment is payable to "CDPH-RHB." It is vital to include this payment with your application to ensure it is processed without delays.

How long will it take to hear back about my application?

Once your application is submitted, you can expect a notification letter from the CDPH-RHB within 30 calendar days. This letter will notify you if your application was accepted or if further documentation is needed.

What happens if my application is not accepted?

If your application is not accepted, the notification letter will provide specific details regarding what information, documentation, or fees are still required. You will have 30 calendar days to address these issues to have your application reconsidered.

How can I submit the CDPH 8218 form?

The application can be mailed directly to the California Department of Public Health at the address specified in the form: Radiologic Health Branch, MS 7610, Accounts Receivable and Cashiering Unit, P.O. Box 997414, Sacramento, CA 95899-7414. Be sure to include all supporting documents and your payment along with your application.

What should I do with my Social Security number on the application?

It is mandatory to provide your Social Security number on the CDPH 8218 form. This information will be used for identification purposes and may be shared with federal, state, or local agencies as necessary. It is essential to provide your correct Social Security number to avoid any issues with your application.

What if I have not graduated from an approved program?

If you have not graduated from a program that is recognized by the CDPH-RHB, you will need to meet specific prerequisites to qualify for the application. This may include enrolling in a CDPH-RHB approved school or obtaining your credentials through other recognized organizations, such as the American Registry of Radiologic Technologists (ARRT).

What are the potential consequences of providing false information?

If you provide false information on the CDPH 8218 application, it may lead to serious consequences. The California Department of Public Health has the authority to revoke any certificates or permits obtained through fraud or misrepresentation. It is crucial to ensure that all information provided is accurate and truthful.

How can I contact the CDPH-RHB for more information?

If you have further questions or need assistance with your application, you can contact the Registration and Certification Support Unit at the California Department of Public Health. They can be reached at (916) 327-5106 or by mail at the Radiologic Health Branch, MS 7610, P.O. Box 997414, Sacramento, CA 95899-7414.

Common mistakes

When filling out the CDPH 8218 form, a common mistake people make is not using their full legal name. This error can lead to complications, including being denied entry into the examination. Always ensure that your name matches what is listed on official documents.

Another frequent issue is omitting the social security number. Providing this number is mandatory for identification purposes. Failing to include it might delay or even derail the entire application process, as the Department requires this information to process your application.

Many applicants also fail to submit the correct application fee. It's essential to attach a check or money order for $88.00 made out to CDPH-RHB. Incomplete payments will result in an application being rejected, leading to unnecessary delays.

Some individuals incorrectly assume that any form of documentation suffices. It is crucial to provide proper supporting documents as specified. For instance, proof of graduation from an approved school or certification is necessary. Not adhering to these document requirements can lead to rejection of the application.

Misunderstanding submission instructions is another mistake. Applicants must send the complete application, including all required documents and payment, in one envelope addressed to the proper department. Sending items separately can cause confusion and extend processing times.

People often overlook tracking the status of their application. Within 30 calendar days of submission, the CDPH will send a notification. Failing to keep an eye on the timeline and not following up may result in missed communications about the application's status.

Finally, failing to read and understand all instructions on the form leads to errors. Careful attention to detail is vital. Misinterpreting the requirements can not only affect your submission but also create longer delays in obtaining the necessary certification.

Documents used along the form

The Cdph 8218 form, also known as the Radiologic Technologist Fluoroscopy Permit Application, is essential for those looking to obtain a fluoroscopy permit in California. In addition to this form, several other documents are often required to support the application process. Each of these documents contributes valuable information that helps establish eligibility for the permit.

  • California Diagnostic Radiologic Technology Certificate: This certificate verifies that the individual has completed the necessary training and education in radiologic technology. A current certificate is mandatory for the application to be considered.
  • Graduation Diploma or Certificate: Applicants must provide proof of graduation from a CDPH-approved radiologic technologist fluoroscopy school. This document serves as evidence that the applicant has received the education required for the fluoroscopy permit.
  • Documentation of Accreditation: This paperwork confirms that the applicant has graduated from a diagnostic radiologic technology program that holds accreditation from the Joint Review Committee on Education in Radiologic Technology (JRCERT). This is important to ensure the program meets established educational standards.
  • American Registry of Radiologic Technologists (ARRT) Certification: Applicants may need to submit documentation showing they are certified by the ARRT in radiography. Being an active registrant with ARRT demonstrates that the individual has passed all relevant examinations and is qualified in the field.
  • Payment for Application Fee: A non-refundable application fee of $88.00 must accompany the application. This fee can be paid via a check or money order made out to the California Department of Public Health Radiologic Health Branch.

Having these documents ready and properly completed will facilitate a smoother application process. It is crucial to ensure that all information is accurate to avoid delays or complications when applying for the fluoroscopy permit.

Similar forms

The CDPH 8218 form, used for obtaining a Radiologic Technologist Fluoroscopy Permit in California, shares similarities with several other documents commonly used in similar contexts. Here are four comparable forms and how they relate:

  • ARRT Certification Application: Like the CDPH 8218, the ARRT Certification Application requires personal information, proof of qualifications, and adherence to specific regulations. Both forms must be submitted with fees and are tied to certification for radiologic technology.
  • California Radiologic Technologist Certificate Application: This application, similar to the CDPH 8218, demands a demonstration of educational qualifications and completion of exams. Both forms serve as necessary steps for practitioners looking to validate their professional credentials within California.
  • Diagnostic Imaging Modality Application: This application also focuses on certifying a healthcare practitioner in a specific imaging modality. Requirements for personal data, proof of education, and acceptable fees bear similarities to those in the CDPH 8218, reflecting core principles in radiologic health certification.
  • Radiation Safety Training Application: Similar to the CDPH 8218, this application ensures that individuals have completed required safety training before practice. It also requires the submission of training documentation and personal details, aligning the safety protocols within the field.

Dos and Don'ts

When filling out the CDPH 8218 form, it is crucial to follow certain guidelines to ensure your application is processed smoothly. Here are six important do’s and don’ts:

  • Do use your full legal name as it appears on official documents.
  • Do provide your Social Security number, as it is mandatory for identification purposes.
  • Do include the non-refundable application fee of $88.00 with your submission.
  • Do send all supporting documents along with your application to avoid delays.
  • Don't submit the application without verifying that all required information is complete.
  • Don't forget to check for any specific documents or fees that may be required to support your application.

By following these guidelines, applicants can enhance the chances of a successful application submission and avoid unnecessary complications.

Misconceptions

Misconceptions about the CDPH 8218 form can lead to confusion and mistakes during the application process for a Radiologic Technologist Fluoroscopy Permit. Below are five common misconceptions explained.

  • My Social Security Number is Optional: Some individuals believe that providing a social security number is not mandatory. In fact, according to California law, supplying this number is required for identification purposes.
  • Graduates from Any Radiologic Program Qualify: There is a misconception that any radiologic technology program will suffice. However, applicants must graduate from a California Department of Public Health approved program or an accredited institution recognized by the Joint Review Committee on Education in Radiologic Technology (JRCERT).
  • Application Fees are Refundable: Many assume that application fees can be refunded if the application is not accepted. In reality, the application fee of $88.00 is non-refundable, regardless of the outcome of the application process.
  • I Will Be Notified Immediately: Some applicants expect to receive immediate notifications after submitting their applications. Typically, the California Department of Public Health will mail a notification letter within 30 calendar days of receipt of your application.
  • Completing the Form is Enough: There’s a belief that merely filling out the CDPH 8218 form is sufficient for the application. This is not true; applicants must also provide appropriate documentation and payment along with the form for their application to be considered.

Understanding these misconceptions helps streamline the application process and ensures that applicants meet all necessary requirements efficiently.

Key takeaways

Filling out and using the CDPH 8218 form can be straightforward if you follow these key takeaways:

  • Use Your Full Legal Name: Make sure to provide your full legal name as any discrepancies may lead to denial of examination entry.
  • Application Requirements: You must include either your current California Diagnostic Radiologic Technology Certificate number or documentation of your application for this certificate along with your ARRT Certificate in Radiography.
  • Social Security Number: Providing your social security number is mandatory. It will be used for identification and may be shared with relevant agencies.
  • Pay Attention to Fees: Ensure you include the non-refundable application fee of $88. Payment can be made via check or money order, made out to CDPH-RHB.
  • Submission Process: All applications, along with required documents and payment, should be mailed to the designated address to ensure proper processing.
  • Notification Timeline: Expect to receive a notification letter within 30 days of submission. This letter will inform you whether your application was accepted or rejected and what steps to take next.