Form R 70 Lso Arrt PDF Details

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Form NameForm R 70 Lso Arrt
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesColorado, Radiologic, X-Ray, 90-day

Form Preview Example

State of Colorado

Department of Public Health & Environment

R-70 Application for Registration

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) 692-3448 or (888) 569-1831 ext. 3448 toll-free (outside the 303 area code) or fax (303) 691- 7841 Attention: X-Ray Certification Unit.

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:





Date of Birth









Mailing Address:














Zip Code:







Business Phone Number

Cell Phone Number

Other Phone Number









Email Address:













Employer/Business Name:




Facility Registration #:









Employer/Business Address:













Zip Code:








Examination Modules (Check all that Apply) :

Core Chest Extremity Spine Skull

Are you Disabled? YES


(Visit for more information on disability

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 window-date expire, will lose exam

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 90-day window forfeit the processing fee and will have to re-apply and pay the complete registration fee for another 90-day window. No training materials are provided by the Department or the ARRT. If you have not received a confirmation notice regarding this registration within 4 weeks after submitting this form, please contact the Department at 303-692-3448. Once submitted, you will receive instructions regarding your exam from the American Registry of Radiologic Technologist (ARRT) in Minnesota before your scheduled exam date.

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


Mail to:

Colorado Department of Public Health and Environment

HMWM-B2 X-Ray Certification

4300 Cherry Creek Drive South

Denver, CO 80246-1530

Fax to:

Email to:



Office Use Only







Approval Denial








Reviewer signature:












Supervisor Signature:












Method of Payment:




ARRT Fee: Cashie ’s Check ( #_________________) Money Order(#____________________)

Staff Initials:


CDPHE Fee: Check (#______________________) Credit Card Staff Initials:




R-70 LSO ARRT Examination Registration (05/2015)



General Instruction

R-70 Registration for Limited Scope Operator

Application - State ARRT Examination

The Colorado Rules and Regulations Pertaining to Radiation Control, 6 CCR 1007-1 (the Regulations), Part 2, requires that any person operating an x-ray machine on human patients be adequately trained. For uses other than dental, podiatry or chiropractic, operators must meet the requirements of Section and Appendix 2D. If an operator is not registered with the American Registry of Radiologic Technologist (ARRT) as a Radiologic Technologist, they must register with the Department as a Limited Scope Operator before exposing a patient. Please review the requirements of Part 2, Appendix 2D to ensure your training is sufficient before you submit your application and fees. Fees are non-refundable.

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 R-70 Application for Registration - Limited Scope Operator and Form R-71 Didactic Training and Clinical Experience For Limited Scope Operator . The application to take the ARRT LSO examination must be made within one year upon completion of the didactic requirements and within ninety (90) calendar days upon completion of the clinical experience requirements. The application must be accompanied with two separate checks: 1) $125.00 Test Fee pa a le to ARRT i the fo of a Cashie ’s he k, certified check or money order, and 2) a $60.00 Application Fee payable to the Colorado Department of Public Health and Environment (CDPHE) in the form of personal check, money order or credit card. Applications will be processed only with the proper funds attached. Fees are non-refundable. Initially, the applicant must apply for all five examination modules; Core, Chest, Extremity, Spine and Skull. If your application is complete, the Department will send your contact information to the ARRT and the ARRT will mail testing information to you. Test scores are sent to the Department directly. An applicant must score at least 75% correct on the Core module and at least 75% correct on the average of the Chest, Extremity, Spine and Skull modules.

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 two-year registration period. If the test scores are not passing, the applicant is sent a letter showing the test score for each module.

R-70 LSO ARRT Examination Registration (05/2015)


Form R-90 Application for Registration Limited Scope Operator Renewal ust e used to e e ou egistration. The

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 ARRT-app o ed o ti ui g edu atio u its eu’s i topi s elated to radiologic technology. It is illegal to operate a radiation machine on human patients if your registration is expired.

If you have questions concerning this application, please call 303-692-3448 or (888) 569-1831 ext. 3448 toll-free (outside the 303 area code), or fax to 303-691-7841 Attention: X-Ray Program, or email to You may also check our website: for more information.

R-70 LSO ARRT Examination Registration (05/2015)

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