In the listing, there is some information in regards to the form r 70 lso arrt. It could be beneficial to find out its size, the typical time to complete the form, the blanks you should fill in, and so on.
| Question | Answer |
|---|---|
| Form Name | Form R 70 Lso Arrt |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | Colorado, Radiologic, X-Ray, 90-day |
State of Colorado
Department of Public Health & Environment
Limited Scope Operator
INSTRUCTIONS: This application must have original signatures and dates. Please provide all information requested on this form. Send the original completed form with all attachments to the Colorado Department of Public Health and Environment (see addresses below). Please retain a copy of the completed application form for your records. This form must be submitted with the required documentation and fees. Two fee payments must be submitted with the application (see instructions). For questions about completing this form, please call (303)
Application Category (check one):
APPLICATION DATE:_______________________ |
New Application |
Retake Examination |
Please check all that apply:
I am applying using my registration with another state. State:________ License#:__________________________________________
I have taken this exam before.
I was scheduled before and did not take exam.
I have enclosed a Cashier’s check or money order for $125.00 payable to the ARRT. (NOTE HIGHER ARRT FEE TO TAKE TEST EFFECTIVE 1/1/15)
I have enclosed a check or money order for application processing fee of $60.00 payable to the CDPHE.
Application Information:
|
Applicant’s Name: |
|
SSN: |
|
|
Date of Birth |
|
|
|
|
|
|
|
|
Mailing Address: |
|
|
|
|
|
|
|
|
|
|
||
|
City: |
State: |
Zip Code: |
|||
|
|
|
|
|
||
|
Business Phone Number |
Cell Phone Number |
Other Phone Number |
|||
|
|
|
|
|
|
|
|
Email Address: |
|
|
|
|
|
|
|
|
|
|
|
|
|
Employer/Business Name: |
|
|
|
Facility Registration #: |
|
|
|
|
|
|
|
|
|
Employer/Business Address: |
|
|
|
|
|
|
|
|
|
|||
|
City: |
State: |
Zip Code: |
|||
|
|
|
|
|
|
|
Examination Modules (Check all that Apply) :
Core Chest Extremity Spine Skull
Are you Disabled? YES |
NO |
(Visit
accommodations related to ARRT testing)
Examinees who do not attend a scheduled appointment, who do not cancel an appointment on time, or who let the assigned
eligibility. E a i do s a e e te ded at the Depa t e t’s dis etio afte o fi i g e eipt of itte e uest f o the e a i ee. Persons who fail to test during the
I have read and understand the statements contained on this form. I certify that the information I have provided above is true and correct.
Applicants Signature
Date
Mail to:
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, CO
Fax to:
Email to:
cdphe.hmxraycomments@state.co.us
|
Office Use Only |
|
|
|
|
|
|
|
Approval Denial |
|
|
|
|
|
|
|
Reviewer signature: |
|
Date |
|
|
|
|
|
|
|
|
|
Supervisor Signature: |
|
Date |
|
|
|
|
|
|
|
|
|
Method of Payment: |
|
|
|
ARRT Fee: Cashie ’s Check ( #_________________) Money Order(#____________________) |
Staff Initials: |
|
|
CDPHE Fee: Check (#______________________) Credit Card Staff Initials: |
|
|
|
|
|
|
General Instruction
Application - State ARRT Examination
The Colorado Rules and Regulations Pertaining to Radiation Control, 6 CCR
Applications must be legible and accurate. The mailing address listed on this application will be used by both the Department and the ARRT to send information to you. The email address or phone number may be used to contact you if correspondence is returned by the Post Office.
New Application:
A new applicant must demonstrate that they have met the training requirements in the Regulations before they can be scheduled to take the ARRT LSO test. The applicant must attach proof of the didactic (classroom) training documenting at least 80 hours of class time on the topics listed in Part 2, Appendix 2D.2.1. The applicant must show at least 480 hours of clinical experience. At least 320 hours must be spent working in a clinic under personal supervision by a qualified operator working with living patients. No more than 160 hours of practical experience may be gained in a teaching laboratory on phantoms. Finally, the applicant must attach documents showing 80 examinations performed under personal supervision during the clinical experience, as listed in Section 2D.2.3. When all required training is completed, the student may apply to the Department to be scheduled for the ARRT LSO test.
Transfer from different state: If you are using a certification from a different state, you must provide documentation that your current state requirements are at least equivalent to Colorado requirements. A $60 fee is required to process this application. An ARRT testing fee is not required if your current certification meets Colorado requirements.
Apply to take ARRT test: If you have completed supervised training and are applying to take the ARRT LSO test, you must complete both Form
Retesting: If an applicant does not score above 75%, they may retake any one or all modules to improve their final score. Each attempt requires payment of both fees as listed above. If an applicant cannot score above 75% after three attempts, they must repeat the training requirements of Appendix 2D and submit a new application when that training is completed.
When the test scores have been evaluated by the Department, a letter will be sent to the applicant. If the test scores are passing, the registration is approved and the applicant is sent a certificate and letter granting a
Renewal:
Form
applicant should renew their LSO registration at least 30 days prior to expiration to avoid a gap in registration. The applicant must document at least 24 hours of
If you have questions concerning this application, please call