Navigating through the complexities of the RHB 313A form reveals a meticulous framework designed to validate and acknowledge the expertise of individuals aiming to become authorized users of radioactive materials within medical settings in California. This form, serving as a gateway, ensures that applicants possess the necessary training, experience, and board certification relevant to the specialty they wish to practice. It meticulously categorizes authorization requirements into areas such as the use of unsealed byproduct material, uptake, dilution, excretion studies, and imaging, alongside localization studies which demand strict adherence to protocols for safety and effectiveness. Additionally, the form extends to those seeking to broaden their scope of practice, necessitating documentation of further education and hands-on experience. At its core, the RHB 313A form embodies a comprehensive attestation process, inclusive of a preceptor's verification of an applicant's capabilities, solidifying the individual's competence and ensuring public health and safety. This structured approach not only underscores the significance of specialized training but also emphasizes ongoing education, making it a pivotal component in the licensing and regulation of medical professionals handling radioactive substances.
Question | Answer |
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Form Name | Rhb Form 313A |
Form Length | 7 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 1 min 45 sec |
Other names | Parenteral, NaI-131, RHB, 10cfr35 |
or equivalent Agreement State requirements (attach a copy of the NRC or Agreement State license). Check all that apply.
□35.190 □ 35.290
□ |
35.390 |
or |
□ 35.392 and/or □ |
35.394 |
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35.490 |
or |
□ 35.491 only □ |
35.690 |
Page 1 of 7
For 2008 10 CFR 35, visit http://www.access.gpo.gov/nara/cfr/waisidx_08/10cfr35_08.html.
RHB FORM 313A (AU) |
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH |
AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)
b.If currently authorized under 35.100 requesting 35.200 authorization, provide documentation on classroom and laboratory training and supervised work experience. The tables in sections 3.a. and 3.b. may be used to document this experience. Also provide completed Part II Preceptor Attestation.
c.If currently authorized under 35.100 and/or 35.200 and requesting 35.300 authorization, provide documentation on classroom and laboratory training, supervised work experience, and supervised clinical case experience. The tables in sections 3.a., 3.b., and 3.c. may be used to document this experience. Also provide completed Part II Preceptor Attestation.
d.If currently authorized for 35.390 and requesting authorization for 35.290 only, provide documentation on generator experience in table 3.b.
e.If currently authorized for a subset of clinical uses under 35.300, requesting additional subset of clinical uses, provide documentation on additional required supervised clinical case experience. The table in section 3.c. may be used to document this experience. Also provide completed Part II Preceptor Attestation. If requesting 35.100, 35.200, and/or 35.300 authorization(s), provide documentation on classroom and laboratory training, supervised work experience, and supervised clinical case experience. The tables in sections 3.a., 3.b., and 3.c. may be used to document this experience. Also provide completed Part II Preceptor Attestation.
f.If currently authorized under 35.490 or 35.690 and requesting authorization for 35.396, provide documentation on classroom and laboratory training, supervised work experience, and supervised clinical case experience. The tables in sections 3.a., 3.b., and 3.c. may be used to document this experience. Also provide completed Part II Preceptor Attestation.
g.If currently authorized under any of the above uses and seeking 35.500 authorization, provide documentation on training on use of the requested device(s). Table in section 3.d. may be used to document this experience.
□3. Training and Experience for Proposed Authorized User
a.Classroom and Laboratory Training (completion of this table is required for all authorizations)
Description of Training |
Location of Training |
Clock Hours |
Dates of |
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Training* |
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Radiation physics and instrumentation |
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Radiation protection |
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Mathematics pertaining to the use and |
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measurement of radioactivity |
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Chemistry of byproduct material for medical |
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use (not required for 35.590) |
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Radiation biology |
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Total Hours of Training: |
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b.Supervised Work Experience (completion of this table is not required for 35.590).
(If more than one supervising individual is necessary to document supervised work experience, provide multiple copies of this section.)
Supervised Work Experience |
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Total Hours of Experience: |
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Description of Experience |
Location of Experience/License or Permit |
Confirm |
Dates of |
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Must Include: |
Number of Facility |
Experience* |
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Ordering, receiving, and unpacking |
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□ Yes |
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radioactive materials safely and |
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performing the related radiation surveys |
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□ No |
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Page 2 of 7
For 2008 10 CFR 35, visit http://www.access.gpo.gov/nara/cfr/waisidx_08/10cfr35_08.html.
RHB FORM 313A (AU) |
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH |
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AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued) |
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Performing quality control procedures on |
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Yes |
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instruments used to determine the |
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activity of dosages and performing |
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checks for proper operation of survey |
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□ No |
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meters |
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Calculating, measuring, and safely |
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□ Yes |
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preparing patient or human research |
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subject dosages |
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□ No |
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Using administrative controls to prevent |
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□ Yes |
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a medical event involving the use of |
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unsealed byproduct material |
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□ No |
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Using procedures to contain spilled |
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□ Yes |
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byproduct material safely and using |
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proper decontamination procedures |
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□ No |
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Administering dosages of radioactive |
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□ Yes |
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drugs to patients or human research |
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subjects (not required for 35.390, 35.392, |
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□ No |
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35.394, and 35.396) |
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Eluting generator systems appropriate |
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□ Yes |
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for the preparation of radioactive drugs |
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for imaging and localization studies, |
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measuring and testing the eluate for |
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No |
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radionuclide purity, and processing the |
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eluate with reagent kits to prepare |
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labeled radioactive drugs (required for |
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35.290) |
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Supervising Individual
License/Permit Number listing supervising individual as an authorized user (if not listed on a California Radioactive Materials License, attach a copy of NRC or Agreement State license)
Supervisor meets the requirements below, or equivalent Agreement State requirements (check all that apply)**.
□35.190
□35.290
□35.390
□35.390 + generator
experience in 35.290(c)(1)(ii)(G)
□ 35.392
□ 35.394
□ 35.396
With experience administering dosages of:
□Oral
□Oral
□Parenteral administration of
□Parenteral administration of any other radionuclide requiring a written directive
**Supervising Authorized User must have experience in administering dosages in the same dosage category or categories as the individual requesting authorized user status.
Page 3 of 7
For 2008 10 CFR 35, visit http://www.access.gpo.gov/nara/cfr/waisidx_08/10cfr35_08.html.
RHB FORM 313A (AU) |
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH |
AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)
c.Supervised Clinical Case Experience (completion of this table is not required for 35.190, 35.290, and 35.590)
(If more than one supervising individual is necessary to document supervised work experience, provide multiple copies of this section.)
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Number of Cases |
Location of Experience/License |
Dates of |
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Description of Experience |
Involving Personal |
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or Permit Number of Facility |
Experience* |
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Participation |
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Oral administration of sodium iodide |
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requiring a written directive in quantities less |
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than or equal to 1.22 gigabecquerels (33 |
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millicuries) |
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Oral administration of sodium iodide |
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requiring a written directive in quantities |
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greater than 1.22 gigabecquerels (33 |
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millicuries) |
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Parenteral administration of any |
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or |
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energy less than 150 keV for which a written |
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directive is required |
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Parenteral administration of any other |
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radionuclide for which a written directive is |
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required |
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(List radionuclides) |
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Supervising Individual
License/Permit Number listing supervising individual as an authorized user (if not listed on a California Radioactive Materials License, attach a copy of NRC or Agreement State license)
Supervisor meets the requirements below, or equivalent Agreement State requirements (check all that apply)**.
□35.390
□35.392
□35.394
□35.396
With experience administering dosages of:
□Oral
□Oral
□Parenteral administration of
□Parenteral administration of any other radionuclide requiring a written directive
**Supervising Authorized User must have experience in administering dosages in the same dosage category or categories as the individual requesting authorized user status.
d.For 35.590 only, provide documentation of training on use of the device.
Device
Type of Training
Location and Dates
e. For 35.500 uses only, stop here. For All other uses, complete Part II Preceptor Attestation.
Page 4 of 7
For 2008 10 CFR 35, visit http://www.access.gpo.gov/nara/cfr/waisidx_08/10cfr35_08.html.
RHB FORM 313A (AU) |
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH |
AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)
PART II – PRECEPTOR ATTESTATION
Note: This part must be completed by the individual's preceptor. The preceptor does not have to be the supervising individual as long as the preceptor provides, directs, or verifies training and experience required. If more than one preceptor is necessary to document experience, obtain a separate preceptor statement from each.
By checking the boxes below, the preceptor is attesting that the individual has knowledge to fulfill the duties of the position sought and not attesting to the individual's "general clinical competency."
First Section
For 35.190: Check one of the following and skip to Third Section
Board Certification
□I attest that __________________________________ has satisfactorily completed the training and experience
Name of Proposed Authorized User
requirements 10 CFR 35.190(a)(1) and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35.100.
OR
Training and Experience
□I attest that __________________________________ has satisfactorily completed the 60 hours of training and
Name of Proposed Authorized User
experience, including a minimum of 8 hours of classroom and laboratory training, as required by 10 CFR 35.190(c)(1), and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35.100.
For 35.290: Check one of the following and skip to Third Section
Board Certification
□I attest that __________________________________ has satisfactorily completed the training and experience
Name of Proposed Authorized User
requirements 10 CFR 35.290(a)(1) and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35.100 and 10 CFR 35.200.
OR
Training and Experience
□I attest that __________________________________ has satisfactorily completed the 700 hours of training and
Name of Proposed Authorized User
experience, including a minimum of 80 hours of classroom and laboratory training, as required by 10 CFR 35.290(c)(1), and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35.100 and 10 CFR 35.200.
For 35.390: Check one of the following and continue to Second Section
Board Certification
□I attest that __________________________________ has satisfactorily completed the training and experience
Name of Proposed Authorized User
requirements in 35.390(a)(1).
OR
Page 5 of 7
For 2008 10 CFR 35, visit http://www.access.gpo.gov/nara/cfr/waisidx_08/10cfr35_08.html.
RHB FORM 313A (AU) |
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH |
AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)
Training and Experience
For 2008 10 CFR 35, visit http://www.access.gpo.gov/nara/cfr/waisidx_08/10cfr35_08.html.
RHB FORM 313A (AU) |
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH |
AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)
□Parenteral administration of any
□Parenteral administration of any other radionuclide for which a written directive is required
Second Section (required for 35.390, 35.392, 35.394, and 35.396 only)
Complete and continue to Third Section
□I attest that __________________________________ has satisfactorily completed the required clinical case
Name of Proposed Authorized User
experience required in 35.390(b)(1)(ii)(G) listed below, and has satisfactorily achieved a level of competency to function independently as an authorized user for:
□Oral
□Oral
□Parenteral administration of
□Parenteral administration of any other radionuclide requiring a written directive
Third Section
Complete the following for preceptor attestation and signature:
□I meet the requirements below, or equivalent Agreement State requirements, as an authorized user for:
□ 35.190 |
□ 35.290 |
□ 35.390 |
□ 35.390+ generator experience |
□ 35.392 |
□ 35.394 |
□ 35.396 |
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Complete the following for 35.390, 35.392, 35.394, and 35.396.
□I have experience administering dosages in the following categories for which the proposed Authorized User is requesting authorization.
□Oral
□Oral
□Parenteral administration of
□Parenteral administration of any other radionuclide requiring a written directive
Name of Preceptor
Signature
Telephone Number
Date
License/Permit Number and Facility Name (if not a California Radioactive Materials License, attach a copy of NRC or Agreement State license)
Page 7 of 7