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MAMMOGRAPHY UNIT TRANSFER/DISPOSAL FORM TEXAS DEPARTMENT OF STATE HEALTH SERVICES RADIATION SAFETY LICENSING BRANCH (RSSB) P.O. Box 149347 Austin, Texas 787149347 This form can be used to notify the
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How to Fill Out Mammography Machine Transfer/Disposal Form:

01
Begin by gathering all the necessary information for the form. This includes the details of the mammography machine being transferred or disposed of, such as the make, model, and serial number.
02
Fill out the section that requires information about the transferee or recipient of the mammography machine. Include their name, contact information, and any relevant organization or facility details.
03
Provide details about the transfer/disposal process. Indicate whether the machine is being transferred to another facility or if it is being disposed of. Include the date of transfer or disposal.
04
If the machine is being transferred to another facility, provide information about the receiving facility. Include their name, contact information, and any relevant details about the facility.
05
Include any additional information or remarks that may be required. This could include details about the condition of the machine, any special instructions or considerations regarding the transfer or disposal, or any other relevant information.
06
Make sure to sign and date the form to certify its accuracy and completeness. If required, have any additional parties involved in the transfer or disposal sign the form as well.

Who Needs Mammography Machine Transfer/Disposal Form:

01
Facilities or organizations that are transferring mammography machines to other facilities or disposing of them would typically need to fill out this form. This includes hospitals, clinics, imaging centers, or any other healthcare or diagnostic facilities that use mammography equipment.
02
Regulatory bodies or government agencies may also require the completion of this form as part of their oversight and tracking of mammography equipment transfers and disposals.
03
The form may also be needed for legal or documentation purposes, particularly when it comes to ownership and accountability of the mammography machine during the transfer or disposal process.
In summary, anyone involved in transferring or disposing of a mammography machine and any related facilities, regulatory bodies, or organizations would need to fill out the mammography machine transfer/disposal form. It is important to accurately provide the required information and ensure the form is properly signed and dated.
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The mammography machine transfer disposal form is a document used to report the transfer or disposal of a mammography machine.
The owner or operator of a mammography machine is required to file the transfer disposal form.
The form can be filled out with information about the transfer or disposal of the mammography machine, including details such as the new owner or the method of disposal.
The purpose of the form is to ensure proper documentation of the transfer or disposal of mammography machines for regulatory compliance.
Information such as the current owner, new owner, date of transfer or disposal, and method of disposal must be reported on the form.
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