Form Cms-1882 - Portable Xray Survey Report Page 4
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10name of facility
not
standards
code
met
n/a
eXplanatory statement
met
(2) for those whose training was completed prior to
July 1,1966, but on or after July 1, 1960: Successful
completion of 24 full months of training and/or experience
under the direct supervision of a physician who is certified
in radiology by the american board of radiology or who
possesses qualifications which are equivalent to those
required for such certification, and at least 12 full months of
pertinent portable X-ray equipment operation experience in
the 5 years prior to January 1, 1968.
(3) for those whose training was completed prior to
July 1, 1960: Successful completion of 24 full months of
training and/or experience of which at least 12 full months
were under the direct supervision of a physician who is
certified in radiology by the American Board of Radiology or
who possesses qualifications which are equivalent to those
required for such certification, and at least 12 full months of
pertinent portable X-ray equipment operation experience in
the 5 years prior to January 1, 1968.
(4) for those whose training was completed prior to
January 1, 1993, successful completion of a program of
formal training in X-ray technology in a school approved
by the council on education of the american medical
association, or by the american osteopathic association
is acceptable.
H22
no. of technologists meeting: 1.___ 2.___ 3.___
license required?
yes
no
H23
(b) personnel orientation
the supplier of portable X-ray services has an orientation
program for personnel based on a procedural manual which
is: available to all members of the staff, incorporates relevant
portions of professionally recognized documents, and includes
instruction in all of the following:
H24
(1) precautions to be followed to protect the patient from
unnecessary exposure to radiation;
H25
(2) precautions to be followed to protect an individual
supporting the patient during X-ray procedures from
unnecessary exposure to radiation;
4
form cms-1882 (02/09)
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