Change of Information for Radiation Device
Idaho Bureau of Laboratories
Radiation Control Program
For Office Use Only

License #:

License date:

Renewal date: 

In compliance with the provisions of the Idaho Radiation Control Rules IDAPA 16.02.27, the Department of Health and Welfare requires licensure of all X-ray producing machines.  Please notify the Department within ten (10) days of any change in the following information.  This form can be found at on the Lab Certification and X-Ray Licensure page.

Note:  Licensure does not imply approval or disapproval of installation.  Licensure does not indicate compliance with all Idaho regulations as applicable to radiation machines.  Inspection reports should be kept as evidence of compliance.
By submitting this form, you are certifying that the information contained herein is true and correct to the best of your knowledge.
Form revised 2/2020
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License number:
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Radiographic Machine Listing