DTC

Nuclear Medicine Forms

The following forms are posted for your use. If any of these will be helpful to your facility please don't hesitate to download them for your use. These forms are produced to meet the regulations of the NRC. They may not be completely applicable to some requirements of some agreement states. Send us an email if you find them useful or if there are additional forms you would find useful not posted here.

• Facility ALARA Review Form
• Cleaning Form
• Daily Area Survey (page 1)
• Daily Area Survey (page 2)
• Dose Calibrator Daily Check Log
• Dose Calibrator Linearity Test
• Decay-In-Storage Log
• Molydenum-99 Concentration
• Multi-Dose Log (for Tc-99M kit preparation and administration)
• Multi-Dose Log (for kits other than Tc-99M)
• Package Receipt and Monitoring Log
• Patient Release (maximum likely dose to an individual exposed to a patient administered NaI-131 for therapy)
• Personnel / Clothing Survey Log
• Nursing Instructions for Patients Treated with Temporary Implant Sources
• Nursing Instructions for Patients Treated with Iodine-131, Phosphorus-32 or Gold-198
• Rules for the Safe Use of Radiopharmaceuticals
• Spill Procedures
• Radioactive Materials Spill Report
• Radioactive Spill Contamination Survey
• Unit Dose / Multi-Dose Use Log
• Weekly Area Survey Form (page 1)
• Weekly Area Survey Form (page 2)