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   The Division of Environmental Health licenses, certifications, and permits

Learn more about the Division of Environmental Health

Medical Program

The application is for all medical use of radioactive material used by hospitals, clinics, private physicians, nuclear pharmacies or accelerator production of medical nuclides.  Adapt the application(s) to fit the proposed use and/or facility.  

NOTE:  Each year on each billing date, if you intend to use the small business discount, you must re-submit a new completed and notarized Small Business Discount Certification.

For further information contact Curt DeMaris, 360-236-3223

For files which require a viewer go to http://www.doh.wa.gov/viewer.htm to download a viewer. If the type of package you are interested in is not available on-line, please contact us to receive a printed copy.

New Licenses
 

• Medical Application DOH 322-016 (PDF, 1.37 MB) 
• Medical Application  (MS Word, 955KB)
  • Instructions DOH  322-026 (PDF, 245.54KB)

• Nuclear Pharmacy and/or Accelerator Production of Medical Nuclides Application (MS Word, 436 KB)

• Nuclear Pharmacy and/or Accelerator Production of Medical Nuclides Application (PDF, 713 KB)
  • Accelerator Production - NUREG-1556, Vol. 21
  • Nuclear Pharmacy - NUREG 1556, Vol 13

• Appropriate fees - Current Fees

• Completed City-County Notification Form
• Small Business Discount Certification (if applicable)

Send completed application packet to:

Washington State Department of Health

Radioactive Materials Section

P.O. Box 47827

Olympia, Washington 98504-7827

  Be sure to:

• Complete the entire form.

• Make a check made payable to the Department of Health

• Enclose original, signed copy of your radioactive materials license application with supporting information.

• Keep a copy for your records

Renewal Licenses

Renewal applications must be received 30 days prior to expiration of the current license.  This qualifies your license for timely renewal which allows your current license to remain in effect until the Department has processed your application.  Information contained in previous applications regarding only initial training and qualifying experience, such as training certificates and medical preceptor statements, may be incorporated by reference.

A renewal package consists of:

• Signed application
  • Medical Application DOH 322-016  (PDF, 1.37 MB) 
  • Medical Application (MS Word, 955KB)
    • Instructions DOH  322-026 (PDF, 245.54KB)

  • Nuclear Pharmacy and/or Accelerator Production of Medical Nuclides Application (MS Word, 436 KB)

  • Nuclear Pharmacy and/or Accelerator Production of Medical Nuclides Application (PDF, 713 KB)
    • Accelerator Production - NUREG-1556, Vol. 21
    • Nuclear Pharmacy - NUREG 1556, Vol 13

• Completed City-County Notification Form (for changes in location)

Annual fees are billed separately.  Renewal applications are sent to:

Washington State Department of Health

Radioactive Materials Section

P.O. Box 47827

Olympia, Washington 98504-7827

Contact Information
 

For more information call or email the appropriate person.  Send written correspondence to the address below or fax to 360-236-2255.

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Last Update : 12/06/2011 05:01 PM