Form Cms-1882 - Portable Xray Survey Report Page 3
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10name of facility
not
standards
code
met
n/a
eXplanatory statement
met
(b) qualifications of the physician supervisor
portable X-ray services are provided under the supervision of
a licensed doctor of medicine or licensed doctor of osteopathy
who is qualified by advanced training and experience in the
use of X-rays for diagnostic purposes, i.e., he
(1) is certified in radiology by the American Board of Radiology
or by the american osteopathic board of radiology or
possesses qualifications which are equivalent to those
required for such certification, or
(2) is certified or meets the requirements for certification in a
medical specialty in which he has become qualified by
experience and training in the use of X-rays for diagnostic
purposes, or
(3) specializes in radiology and is recognized by the medical
community as a specialist in radiology.
name of board
date
Certification
Certified
no.
specialization
Other Qualifications (specify)
§486.104 qualifications, orientation, and health of
h20
technical personnel (405.1413)
Portable X-ray services are provided by qualified technologists.
H21
(a) qualifications of technologists
all operators of the portable X-ray equipment meet the
requirements of paragraph (a)(1), (2), (3), or (4) of this section:
(1) successful completion of a program of formal training
in x-ray technology in a school approved by the Join
review committee on education in radiologic technology
(JRCERT), or have earned a bachelor’s or associate degree
in radiologic technology from an accredited college or
university
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form cms-1882 (02/09)
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