Application Forms

Technologists Application Forms

 November 30, 2021: 

To all Radiologic Technologists, Radiation Therapists, and Nuclear Medicine Technologists whose licensures are up for renewal on November 30 and December 31, 2021, you will be receiving your WebID letter and instructions in the mail.

The RCP will only be processing November and December renewal and NEW applications at this time.

All other renewing technologists, please wait until you receive your WebID letter in the mail. 

***ALL MAMMOGRAPHY TECHS: If you are an existing Mammography tech whose Radiologic Technology license is due for renewal in either of these time periods, you will need to mail your renewal application, safe injection attestation, and credentialing verification page to the Carson City office to avoid a renewal payment invoice for the Rad Tech licensing.

• INFORMATIONAL NOTICE
  • RCP Technologists Renewals
• Attestation Forms
  • Attestation of Employee Training
  • Attestation of Safe Injection Training
  • Facility Attestation of Employee Licensure

• License Application Forms
  • Full License
  • Limited License
  • Student License

• Registration Application Forms
  • Registration Form for CT or Fluoroscopy prior to 1-1-2020
  • Registration Form for Radiation Therapy or Radiologic Imaging prior to 1-1-2020.
  • Registration form for Rural Authorization
  • Registration Form for the holder of a license to engage in Computed Tomography for Qualifying.
  • Registration Form for the holder of a license or limited license to practice outside of scope

• Change of Address Form

• Name Change Form

• Recognized Continuing Education Organizations

Technologists Fees

Per LCB File No. R043-20 and R074-19, Adopted Regulations

• Technologists Licensing and Registration Fees

Mammography Application Forms

General Forms

• Notice to Employees Form
• Mammographer Certificate of Authorization Application (Click here to access our online system)
• Mammography Technologist Change of Information (Click here to access our online system)
• Mammography Technologist Termination Request (Click here to access our online system)
• Mammography Machine Application for Certificate of Authorization (Click here to access our online system)
• Mammography Machine Application for Certificate of Authorization - Addendum 1
• Mammography Machine Application for Certificate of Authorization - Addendum 2
• Mammography Machine Application for Certificate of Authorization - Addendum 3
• Non-MQSA Mammography Machine Annual Registration Form
• Mammography Physicians Supplement
• Template for Physician Experience

Mammography Guidance

• Basic Operational Requirements for Mammography
• Common Mammography Violations
• Adding and Deleting of Interpreting Physicians
• Model Letter for Adding a New Mammography Physician