105 CMR, § 120.421 - Appendix B - Information to be Submitted by Persons Proposing to Conduct Healing Arts Screening

Persons requesting that the Agency approve a healing arts screening program shall submit the following information and evaluation:

(A) Name and address of the applicant and, where applicable, the names and addresses of agents within this Commonwealth.

(B) Diseases or conditions for which the x-ray examinations are to be used in diagnoses.

(C) A detailed description of the x-ray examinations proposed in the screening program.

(D) Description of the population to be examined in the screening program, i.e., age, sex, physical condition, and other appropriate information.

(E) An evaluation of any known alternate methods not involving ionizing radiation, which would achieve the goals of the screening program and why these methods are not used instead of the x-ray examinations.

(F) An evaluation by a qualified expert of the x-ray system(s) to be used in the screening program. The evaluation by the qualified expert shall show that such system(s) do satisfy all requirements of 105 CMR 120.000.

(G) A description of the diagnostic film quality control program.

(H) A copy of the technique charts for the x-ray examination procedures to be used.

(I) The qualifications of each individual who will be operating the x-ray system(s).

(J) The qualifications of the individual who will be supervising the operators of the x-ray system(s). The extent of supervision and the method of work performance evaluation shall be specified.

(K) The name and address of the individual who will interpret the radiograph(s).

(L) Procedures to be used in advising the individuals screened and their practitioner of the healing arts or healthcare provider of the results of the screening procedure and any further medical needs indicated.

(M) The duration of the screening program.

Notes

105 CMR, § 120.421