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Center for Radiation, Chemical and Environmental Hazards Personal Dosimetry Service B1778/S/122 DOSE RECORD KEEPING SERVICE TERMINATION OF DOSE RECORD KEEPING This form is for employers to use to
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How to Fill Out PHE Form 122:

01
Begin by gathering all the necessary information and documents required for filling out the form. This may include personal identification details, medical history, and any relevant supporting documents.
02
Start by entering your personal information, such as your name, address, contact details, and social security number. Ensure that you provide accurate and up-to-date information.
03
Fill out the sections that require information about your medical history, including any pre-existing conditions, allergies, or medications you are currently taking. It is important to be thorough and provide all relevant details to ensure an accurate representation of your health status.
04
If applicable, provide details about any surgeries or medical treatments you have undergone in the past. Include dates, procedures, and the healthcare professionals involved.
05
Answer any additional questions or sections specific to your circumstances. This may include questions about your travel history, exposure to certain diseases, or immunization records.
06
Review the completed form carefully to ensure all fields have been filled out accurately and completely. Double-check for any errors or omissions before proceeding.
07
Once you are satisfied with the information provided, sign and date the form as required. This confirms that the provided information is true and accurate to the best of your knowledge.

Who Needs PHE Form 122:

01
Individuals who are applying for certain medical benefits or services may be required to fill out PHE Form 122. This could include applications for disability benefits, healthcare coverage, or medical assistance programs.
02
Employers may require employees to fill out PHE Form 122 for occupational health and safety purposes. This ensures that the employer has accurate information about their employees' health status and can take appropriate measures to protect their wellbeing.
03
Healthcare providers may use PHE Form 122 to gather essential patient information, especially during emergency situations or when treating a patient for the first time. This helps them understand the patient's medical history and make informed decisions regarding their care.
Note: The specific requirements for who needs PHE Form 122 may vary depending on the country, region, or organization. It is important to consult the relevant authorities or resources to determine the specific situations in which this form is required.
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