No. When the MIRTP has determined that you have submitted a complete application packet, an invoice will be created, and you will be sent a separate email, which will contain a link to make your payment. Santa Fe, New Mexico 87505, Harold L. Runnels Building // 1190 St. Francis Drive, Suite N4050 // Santa Fe, New Mexico 87505 // tel (800) 219-6157, (505) 827-2855, Welcome to the Medical Imaging & Radiation Therapy Program, To view a list of Active NM Medical Imaging and Radiation Therapy Professionals Licensees. Box 5469 . If you would like to know how to pay your fees electronically please, Click Here. Nuclear Medicine & Molecular Imaging Week, Radiopharmaceutical Therapy Centers of Excellence, Nuclear Medicine Clinical Trial Group, LLC, About Nuclear Medicine & Molecular Imaging, Continuing Education Committee (SNMMI-TS). Primary source verification is often required during the sonographer hiring process or when a sonograph er certification, credential, registration, or state license is . Initial Licensure for Medical Imaging and Radiation Therapy application Duplicate or Replacement of Certificate of Licensure application Temporary License application Request for Written Verification form Legal Name Change form Provisional License Application Contact us RCB Main Phone Number: 505-476-8600 Santa Fe, NM 87505, Environmental Emergencies: 505-827-9329 (24 hours), Asbestos Government Ordered Demolition form, Permitting Administrative Multi-Form (PAM), GCP-Oil and Gas Registration Form Part 1 of 2, GCP-Oil and Gas Registration Form Part 2 of 2, GCP-2 Multi-Form for Quarrying, Crushing, and Screening Facilities, GCP-3 Multi-Form for Hot Mix Asphalt Plants, GCP-3 Hot Mix Asphalt Plants Carbon Monoxide Emission Calculation Tool, GCP-5 Multi-Form for Concrete Batch Plants, CommForm Communication Updates for Air Quality Permits or Notices of Intent, GCP-6 Storage Vessels Section 9: Emission Reduction Calculation Table, GCP-Temporary Control Minor Registration Form, GCP-Temporary 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Establishment, Mobile Food Establishment (Food Truck), Food Processing Plant, or Mobile Support Unit, Registration form for baked goods prepared on tribal lands and sold in state, Ground Water Quality Bureau Discharge Permit Application (Non-dairy), Wastewater Land Application Data Sheet- 200 lbs/ac, Wastewater Land Application Data Sheet 125%, Surface Disposal Data Sheet Chile Processing Facilities, Wastewater Sampling Log- Chile & Food Processing Facilities, Dairy Discharge Permit Renewal and/or Modification Application, Dairy Discharge Permit Renewal for Closure Application, Business Concern (Public Owner, Private Operator) Disclosure Statement, Hard copy RCRA Subtitle C Activities Site Identification Form 8700-12, RCRA Subtitle C Activities Site Identification Instructions, OSHA 300, 300A, 301 Formsand Instructions, Initial Incident Report (must be filed within 24 hours of discovering a release), Instructions for completing Initial Incident Report, 30-Day Notification Form for 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Indemnification / Release of Liability Form, License Renewal Application form for Medical Imaging or Radiation Therapy, InitialLicensure for Medical Imaging or Radiation Therapy Application form, Duplicate or Replacement Certificate of Licensure Application form, Temporary Licensure for Medical Imaging or Radiation Therapy Application form, Request for Written Verification Application form, Particle Accelerator Facility Registration, Amendment or Renewal form, Registration to Operate Radiation Machine form, Instructions for Applying to use Radiation Machines, Medical Diagnostic or Industrial Radiation Machine Facility Application, Form Required for Change of Control or Change of Ownership or both (including name change), Authorized Medical Physicist Preceptor (pdf), Authorized Nuclear Pharmacist Perceptor (pdf), Authorized User Diagnostic Use Preceptor (pdf), Authorized User Therapy Use Preceptor (pdf), Authorized User Sealed Source Therapy Use Preceptor (pdf), Instruction on How to fill-out Preceptor Form (pdf), Licensee Ownership Transfer Name Change Form, General License Application Small Uranium Thorium water filtration systems, General License Registration Form Device Attachment, Out of State Radiation Machine 2 day notification, Reciprocity Recognition form instructions, Financial Assurance Estimate Summary (for landfills), Financial Assurance Estimate Summary Simplified (for transfer stations), 2022 Annual Report Form: Tire Recycling Facility, 2022 Annual Report Form: Scrap Tire Hauler, 2022 Annual Report Form: Civil Engineering Applications, Collection Center Registration Application, Compost Facility Registration Application, Recycling Facility Registration Application, Air Curtain Incinerator Registration Application, Small Animal Crematorium Registration Application, Annual Financial Assurance Cost Estimate Form Transfer Station, Annual Financial Assurance Estimate Worksheets, Irrevocable Standby Letter of Credit (NM Gov Ent as Payee), Irrevocable 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ALL application packets shall be submitted to the Medical Imaging & Radiation Therapy Program (MIRTP) by email to stephen.sanchez@state.nm.us and all fees shall be paid electronically. If you have questions about eligibility, our requirements, or applying, we're here to help. 24 units every 2 years, To be determined by NM State Legislation. Environmental Emergencies: 505-827-9329 (24 hours), Medical Imaging and Radiation Therapy Program, Radiological and Chemical Advocacy Office, Public Notices of Radioactive Material Licensing Actions. Checking the status of a license is an important tool to protect public health and safety and maintain trust in these . Select the contact information from your MiPLUS account. If a nuclear medicine technologist is not certified in diagnostic radiography but is certified in CT can they perform diagnostic CT on a hybrid scanner? How frequently do you have to renew your nuclear medicine technologist license in your state? If you want to become certified and registered with ARRT, you must meet our requirements and apply to ARRT. NMED is associated with a number of boards, commissions, and committees that serve in a regulatory role or as technical advisors. For the annual MIRTAC meeting on 12/10/2019, a motion for a Diagnostic CT credential was introduced. I will not be able to process your request until I receive payment confirmation, which is the separate email that I have requested that must be forwarded to my email address. 7. Your responsibilities will include preparing and injecting radiopharmaceutical agents into patients . For a list of appointed members of the Medical Imaging and Radiation Therapy Advisory Council, click here. If you believe you should have access to this part of our website but do not have a working username and password, please contact the NMTCB office at (404) 315-1739. Applications for licensure to operate x-ray, therapy, or perform nuclear medicine administrations to humans may be submitted and fees paid online. Breast Surgery Associates of New Mexico 101 Hospital Loop NE, Suite 106 Albuquerque, NM 87109 Hours: Monday through Friday: 8:00 a.m. to 5:00 p.m. General Information: (505) 828-0404 Scheduling: (505) 828-0404 Fax: (505) 323-4331 Services Offered: Breast Surgery, Breast Intervention, Genetic Testing, Pain Injections Mailing Address Email a complete application packet to stephen.sanchez@state.nm.us which includes all the required supporting documents that are requested in each type application form. The New Mexico Medical Imaging and Radiation Therapy Program considers this list as Primary Source Verification and certifies this record is accurate to the best of our knowledge as of the date listed on each of the PDF pages of the active status list. License Renewal Application Form for Medical Imaging or Radiation Therapy, Initial Licensure for Medical Imaging or Radiation Therapy Application Form, Duplicate or Replacement Certificate of Licensure Application Form, Temporary Licensure for Medical Imaging or Radiation Therapy Application Form, REQUEST FOR WRITTEN VERIFICATION APPLICATION FORM. Payments included with mailed application packets may be deposited (in accordance with state statute) before an application packet has been fully reviewed and processed. Averification letter request form is available (PDF). The MIRTP recommends ALL application forms andtheir required supporting documents be submittedby email. License Renewal Application form for Medical Imaging or Radiation Therapy . Javascript must be enabled for the correct page display. The SDMS is not a primary source or a credentials verification organization (CVO). Order NMTCB replacement certificates, scrubs, polo shirts, patches, pins, mugs, and more. Section 20.3.20.100 - LICENSE REQUIRED A. What is the name of the license for CT attenuation correction? To request reciprocity in New Mexico, a letter with a copy of the current out-of-state registration/license and a completed request form should be sent at least 2 days in advance of work in the State to: the NM Environment Department Radiation Control Bureau, 1100 St. Francis Drive Suite 2022, P.O. Fax: +1 214.473.8563, 2023 Society of Diagnostic Medical Sonography Indianapolis, Indiana 46204-3003. Certification/Credentialing Organizations. PO Box 5469 Paul, MN 55120-1155. Note: Other Verification Resources includes Retired List, Sanctioned List, Request Status Letter, etc.). Oakbrook Terrace, IL:2018:HR-3. The Bureau may request additional information or impose certain conditions in the recognition letter. Please see the MIRTP web page /rcb/mirtp/ for information regarding how to submit your complete application packet ELECTRONICALLY, and how the ELECTRONIC PAYMENT PROCESS works by clicking on the two links are located below all the application forms that appear on the MIRPT WEB PAGE. A copy of the recognition letter must be maintained on each job site location and all machines and records must be in compliance with the Radiation Protection Rules, subject to inspection during specified hours of use. 8. Board of Directors. Create an account at app.nm.gov to stay up-to-date on the state's programs and services like Unemployment Insurance; Concealed Carry Applications; the Women, Infants, and Children Program; and more. Registration for Radiation Machines. This website, including the certification information provided, is solely maintained by the NMTCB. The ARRT Verify Credential page is located on their web site, click on the following link https://www.arrt.org/pages/verify-credentials Initial Licensure for Medical Imaging and Radiation Therapy Application Form Duplicate or Replacement of Certificate of Licensure Application Form Temporary License Application Form Note that to be licensed as a sonographer, NM requires at least one current sonography certification/credential from the American Registry for Diagnostic Medical Sonography (ARDMS), Cardiac Credentialing International (CCI), or American Registry of Radiologic Technologists (ARRT). (217) 785-9900. The New Mexico Regulation and Licensing Department strives to ensure that New Mexicans receive quality care and services from qualified individuals and businesses in different industries, professions and trades. Other Verification Resources. This section of our website is devoted exclusively to current members of the NMTCB Board of Directors. Radiation Control Bureau Each state's licensure information is considered a "primary source" for a sonographer license. If you would like to know more about how to pay your fees electronically please, click here. It is unlawful for an individual, other than an individual licensed by the department, or who is exempt under the provisions of the act, to: (1) use ionizing or non-ionizing radiation for diagnostic, interventional, or therapeutic purposes on humans; (2) use any title, abbreviation, letters, figures, signs, or other devices to indicate . New Mexico 87505; tel (800) 219-6157 If you have partial information, or not sure of the exact name etc., you may use a wildcard search by placing a '*' following the partial data . Due to COVID-19, most New Mexico State Employees are teleworking from home. After you click on that, you will be taken to another web page. Note: Information is also provided about those who are subject to probation/sanction or not found. Youll need to meet that states requirements. Having trouble finding what you are looking for?Feel free to contact us or use our A to Z page to find an alphabetical list of pages and services available on this site. To be determined by NM State Legislation. Welcome applicants! 1255 Northland DriveSt. Apply to the NM Board of Dental Health Care for a training permit, valid for six months, AND; Pass a state radiography clinical exam, within six months of passing the DANB RHS exam, AND; Pass the New Mexico state jurisprudence exam (take-home), AND; Apply to the New Mexico Board of Dental Health Care for certification to perform radiography. Remember, this is not the same as taking an ARRT exam. If a nuclear medicine technologist is not certified in diagnostic radiography but is certified in CT can they perform diagnostic CT on a standalone CT scanner? Therefore, the SDMS makes no warranty of the information provided by these organizations and state agencies. InstructionsReciprocalRecognition-8The Bureau provides reciprocal recognition to certain holders of valid radioactive material licenses and/or radiation machines registrations issued by out-of-state licensing agencies such as Agreement States or the Nuclear Regulatory Commission. NMED works with all types of businesses in New Mexico to issue permits and licenses for complying with state and federal regulations. Box 5469, Santa Fe, NM 87502-5469; fax 505-476 . 4. Renewal Application Form Revised October 12, 2021 - Page 1 of 4 . Particle Accelerator Facility Registration, Amendment or Renewal form . Environmental Emergencies: 505-827-9329 (24 hours), Medical Imaging and Radiation Therapy Program, Radiological and Chemical Advocacy Office, Public Notices of Radioactive Material Licensing Actions, Initial Licensure for Medical Imaging and Radiation Therapy application, Duplicate or Replacement of Certificate of Licensure application. Indiana State Department of Health. Radiologist Assistant Program Recognition, Didactic and Clinical Competency Requirements. Does your state license radiology technologists? Start by reviewing anoverview of the application processand downloading our primary eligibility pathway application handbook below. For information regarding this page, contact Stephen Sanchez at stephen.sanchez@state.nm.us. This section of our website is devoted exclusively to current members of the NMTCB Board of Directors. MIRTP issued over 3500 professional licensures to operate and administer ionizing and non-ionizing radiation to humans pursuant to 20.3.20 NMAC. That differs from ARRT certification and registration. Essential resources for "primary source" verification of sonographer certification, credential, registration, or state licensure. You can search by license type or licensing board in the search bar below. In some states, you must obtain a state license before you can work as a radiologic technologist there. Asbestos NESHAP Notification form(Instructions) (Example)Asbestos Emergency Notification formAsbestos Government Ordered Demolition form, Permitting Administrative Multi-Form (PAM)AQB ePermitting PortalCompliance History Disclosure FormGCP-Oil and Gas Registration Form Part 1 of 2GCP-Oil and Gas Registration Form Part 2 of 2GCP-Oil and Gas Stack CalculatorAir Emissions Calculation ToolNOI Oil and Gas Abbreviated Portal FormUniversal Air Quality Permit ApplicationGCP-2 Multi-Form for Quarrying, Crushing, and Screening FacilitiesGCP-3 Multi-Form for Hot Mix Asphalt PlantsGCP-3 Hot Mix Asphalt Plants Carbon Monoxide Emission Calculation ToolGCP-5 Multi-Form for Concrete Batch PlantsCommForm Communication Updates for Air Quality Permits or Notices of IntentNSR Equipment Substitution FormNSR Relocation ApplicationGCP-6 Storage Vessels Registration FormGCP-6 Storage Vessels Section 9: Emission Reduction Calculation TableGCP-Temporary Control Minor Registration FormGCP-Temporary Control Major Registration FormACI Title V Permit ApplicationTitle V Application EPA Transmittal FormAcid Rain Program Instructions for Phase II Permit ApplicationAcid Rain New Unit ExemptionLandfill Design Capacity Report FormLandfill NMOC Emission Rate ReportLandfill Closure ReportLandfill Control Equipment Removal ReportRelocation Form For Portable Streamline Compressor EnginesEngine Replacement Form Plume Dispersion Energy ComparisonCotton Gin Permit Application Supplement, Compliance Assessment Agreement formSmall Business Compliance Assessment Program Disclosure formSmall Business Certification form, Smoke Management Ventilation Category Tracking formSmoke Management Visual Monitoring formSmoke Management Statewide Waiver Reporting form, Dry Cleaning Notice of Compliance Status Form2021 Dry Cleaner Compliance CalendarInitial Notification and Notification of Compliance Status Form for Gasoline Dispensing Facilities, Method 9 Opacity record keeping formMethod 22 Observation form, Universal Test 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PhaseEngineering Contract Template Attachment IV Construction PhaseEngineering Contract Template Attachment V Operation PhaseEngineering Contract Template Attachment VI Amendment to Engineering Contract, Disinfection By-Products Stage 2 Operational Evaluation, Distribution System Sampling Plan templateSurface Water Treatment System Monthly Operating Report, Construction or Modification of Public Water Supply System ApplicationConstruction Application Checklist, Construction or Modification Change Order Notification, Construction Project Completion Notification, Potable Water Hauling ApplicationPotable Water Hauling Application Checklist, Virus Inactivation by Chlorine Certification (hypochlorination)Virus Inactivation Certification Checklist, Drinking Water Laboratory Certification Program (DWLCP) Guidance ManualApplication for Laboratory Certification Appendix AChecklist for Laboratory Certification Application Appendix BLaboratory Certification Best Practices Appendix CDWLCP Acknowledgement Form Appendix DSubcontract Lab Request Form Appendix E, Template for Quarterly QA Report Appendix F, Corrective Action Response for Audit Findings Appendix G (Micro Labs Only), Examples of Chain-of-Custody Forms Appendix H, Registration Instructions for SDWIS LabToState Appendix I, Corrective Action Response for PT Study Failures (Micro Labs Only) Appendix J, RTCR Sample Reporting and Notification (LabToState) Appendix K, Public Water System Emergency Response Plan templatePublic Water Systems Operation & Maintenance Plan template, Utility Operator Certification Program exam application, Liquid Waste Permit Search Request Auto Fill PDF FormLiquid Waste Permit Application Auto Fill PDFLiquid Waste Permit or Registration Application printable versionApplication ChecklistSite Plan Submittal ChecklistAffidavit to keep lots/parcels adjoined in perpetuityVariance application | Variance application guidance | Variance ChecklistSample letter for public notice of varianceTank 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Permit Application (Non-dairy)Notice of Intent to DischargeUIC General Discharge Permit ApplicationWastewater Land Application Data Sheet- 200 lbs/acWastewater Land Application Data Sheet 125%Fertilizer LogSurface Disposal Data Sheet SeptageSurface Disposal Data Sheet SludgeSurface Disposal Data Sheet GreaseSurface Disposal Data Sheet Chile Processing FacilitiesWastewater Sampling Log- Chile & Food Processing FacilitiesVoluntary Remediation ApplicationDairy Discharge Permit Renewal and/or Modification ApplicationSupplemental Form 1-R (Dairy)Supplemental Form 2-R (Dairy)Supplemental Form 3-R (Dairy)Supplemental Form 4-R (Dairy)Dairy Discharge Permit Renewal for Closure ApplicationSupplemental Form 1-C (Dairy)Supplemental Form 2-C (Dairy)Supplemental Form 3-C (Dairy)New Dairy Discharge Permit ApplicationSupplemental Form 1-A (Dairy)Supplemental Form 1-B (Dairy)Supplemental Form 1-C (Dairy), Business Concern Disclosure StatementGovernmental Entity Disclosure StatementKey Employee 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FormForms for inspection and testing of spill and overfill prevention equipment and containment sumps(scroll down on the page that this link brings you to until you see Download Appendix, then click on the appropriate form under that), Alternate Method FormRequest for Extension of Temporary Closure of Storage Tank SystemRequest for Compliance DeterminationUST O&M ChecklistAST O&M Checklist, Petroleum Storage Tank Registration FormPetroleum Storage Tank Registration InstructionsChange in Ownership Form, Request for Compliance DeterminationCorrective Action Fund Pamphlet: Processes for Payment from the Corrective Action FundCAF Reimbursement Applications InstructionsResponsible Party Reimbursement Claim FormAffirmation and Assent to AuditCost Detail Form Summary SheetDisclosure Form ConsultantDisclosure Form Tank Owner/OperatorDisclosure Form AffidavitState Lead Claim FormReimbursementQuestions and AnswersCompetitive Bid Guidelines, Application form for first time installer certificationApplication form for renewal of installer certificationApplication form for first time Junior Installer certificationTester qualifications submittal formOperator Training Review Application and Matrix, Aquatics Operating Permit ApplicationConstruction Permit Application FormVariance Application FormVariance Indemnification / Release of Liability FormEmergency Action Plan TemplateDaily Opening ChecklistPool Daily Log sheet ExampleInspection FormInspection FormCheat Sheet, License Renewal Application form for Medical Imaging or Radiation TherapyInitialLicensure for Medical Imaging or Radiation Therapy Application formDuplicate or Replacement Certificate of Licensure Application formProvisional License Application formTemporary Licensure for Medical Imaging or Radiation Therapy Application formRequest for Written Verification Application formLegal Name Change Application form, Particle Accelerator Facility Registration, Amendment or Renewal formParticle Accelerator Registration GuideRegistration to Operate Radiation Machine formInstructions for Applying to use Radiation MachinesMedical Diagnostic or Industrial Radiation Machine Facility Application Form Required for Change of Control or Change of Ownership or both (including name change), Radiation Safety Officer PreceptorAuthorized Medical Physicist Preceptor (pdf)Authorized Nuclear Pharmacist Perceptor (pdf)Authorized User Diagnostic Use Preceptor (pdf)Authorized User Therapy Use Preceptor (pdf)Authorized User Sealed Source Therapy Use Preceptor (pdf)Instruction on How to fill-out Preceptor Form (pdf)Licensee Ownership Transfer Name Change FormGeneral License Application Small Uranium Thorium water filtration systemsGeneral License Registration Form Device AttachmentGeneral License Registration FormRCB Form 014RCB Form 016, Vendor Application GuidanceRadiological Services Application, Instruction Reciprocity RecognitionReciprocity 3-day Notification FormOut of State Radiation Machine 2 day notificationReciprocity Recognition form instructions, Log in to SEPAnnual Report InstructionsLandfill Capacity Calculation WorksheetFinancial Assurance Estimate Summary (for landfills)Financial Assurance Estimate Summary Simplified (for transfer stations)Environmental Monitoring SummaryAnnual Reporting Information FormTutorial: SEP RegistrationTutorial: Logging in to SEP2022 Annual Report Form: Tire Recycling Facility2022 Annual Report Form: Scrap Tire Hauler2022 Annual Report Form: Civil Engineering Applications, Collection Center Registration ApplicationCompost Facility Registration ApplicationRecycling Facility Registration ApplicationAir Curtain Incinerator Registration ApplicationSmall Animal Crematorium Registration Application, Main Disclosure StatementBusiness Concern Disclosure StatementGovernmental Entity Disclosure StatementKey Person Disclosure StatementPersonal History Disclosure StatementBusiness Concern (Public Owner, Private Operator) Disclosure StatementSubsidiary Disclosure Statement, Annual Financial Assurance Cost Estimate Form Transfer StationAnnual Financial Assurance Estimate WorksheetsCertificate of InsuranceIrrevocable Standby Letter of Credit (NM Gov Ent as Payee)Irrevocable Standby Letter of Credit (NMED as Payee)Local Government Reserve ResolutionPerformance Bond (NM Gov Ent as Beneficiary)Performance Bond (NMED as Beneficiary)Standby Trust Agreement (NM Gov Ent as Beneficiary)Standby Trust Agreement (NMED as Beneficiary)Trust Agreement (NM Gov Ent as Beneficiary)Trust Agreement (NMED as Beneficiary), Commercial & Special Waste Hauler Registration FormHelp Completing Hauler Registration FormHelp Completing Contingency Plan (Special Waste Haulers Only)Special Waste Manifest FormHauler Unauthorized Waste Tng Outline, Scrap Tire Hauler Registration FormScrap Tire Hauler Bond FormScrap Tire Manifest Form for HaulersScrap Tire Manifest for Generators (for scrap tire generators that self-haul), Civil Engineering Application (Small) for projects using 101 to 999 scrap tires and that are no more than 2 bales highCivil Engineering Application (Medium) for projects using 1000 to 99,999 scrap tires and that are no more than 2 bales highCivil Engineering Application (Large) for projects using 100,000 scrap tires or more or that are more than 2 bales highTire Recycling/Storage Facility ApplicationAffidavit Of Compliance with Local RegulationsProperty Owner Affidavit of Acknowledgement, Operator Certification Application (Initial)Operator Certification Application (Renewal)Alternate CEU Approval Form, FY24 RAID Grant Recycling ApplicationFY24 RAID Grant Illegal Dumpsite Abatement ApplicationFY24 RAID Grant Additional Dumpsite Information page, Solid Waste Facility Grant Fund Application FY24, On-Site Disposal of Domestic Waste Request FormSWB Rules Document, Headquarters Location
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