ML22117A200
| ML22117A200 | |
| Person / Time | |
|---|---|
| Issue date: | 08/16/2022 |
| From: | NRC/NMSS/DMSST/FSTB |
| To: | |
| B. Sida, NMSS/MSST/MSTB | |
| References | |
| OMB 3150-0120 | |
| Download: ML22117A200 (3) | |
Text
AUTHORIZED NUCLEAR PHARMACIST TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION
[10 CFR 35.55]
NRC FORM 313A (ANP)
(01-2020)
U. S. NUCLEAR REGULATORY COMMISSION NRC FORM 313A (ANP) (01-2020)
PAGE 1 APPROVED BY OMB: NO. 3150-0120 EXPIRES: 01/31/2023 Name of Proposed Authorized Nuclear Pharmacist State or Territory Where Licensed PART I -- TRAINING AND EXPERIENCE (Select one of the two methods below)
- 1. Board Certification
- a. Provide a copy of the board certification and stop here.
Training and Experience, including board certification, must have been obtained within the 7 years preceding the date of application or the individual must have obtained related continuing education and experience since the required training and experience was completed. Provide dates, duration, and description of continuing education and experience related to the nuclear pharmacy uses.
- 2. Structured Educational Program for Proposed Authorized Nuclear Pharmacist Description of Training Radiation physics and instrumentation Location of Training Clock Hours Dates of Training*
Radiation protection Mathematics pertaining to the use and measurement of radioactivity Chemistry of byproduct material for medical use Radiation biology Total Hours of Training:
Classroom and Laboratory Training.
a.
U. S. NUCLEAR REGULATORY COMMISSION NRC FORM 313A (ANP)
(01-2020)
AUTHORIZED NUCLEAR PHARMACIST TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION [10 CFR 35.55] (continued)
Description of Experience Shipping, receiving, and performing related radiation surveys Location of Experience/License or Permit Number of Facility Clock Hours Dates of Experience*
Using and performing checks for proper operation of instruments used to determine the activity of dosages, survey meters, and, if appropriate, instruments used to measure alpha-or beta-emitting radionuclides Calculating, assaying, and safely preparing dosages for patients or human research subjects PAGE 2 Using administrative controls to avoid medical events in administration of byproduct material Using procedures to prevent or minimize radioactive contamination and using proper decontamination procedures Total Hours of Experience:
Supervising Individual
- c. Go to and complete Part II Preceptor Attestation.
b.
- 2. Structured Educational Program for Proposed Authorized Nuclear Pharmacist (continued)
Supervised Practical Experience in a Nuclear Pharmacy.
NRC FORM 313A (ANP) (01-2020)
U. S. NUCLEAR REGULATORY COMMISSION AUTHORIZED NUCLEAR PHARMACIST TRAINING, EXPERIENCE, AND PRECEPTOR ATTESTATION [10 CFR 35.55] (continued)
NRC FORM 313A (ANP)
(01-2020)
PART II - PRECEPTOR ATTESTATION PAGE 3 Note:
This part must be completed by the individual's preceptor. The preceptor does not have to be the supervising individual as long as the preceptor provides, directs, or verifies training and experience required. If more than one preceptor is necessary to document experience, obtain a separate preceptor statement from each.
First Section Complete the following:
Structured Educational Program I attest that Name of Proposed Authorized Nuclear Pharmacist has satisfactorily completed a 700-hour structured educational program consisting of both practical experience in nuclear pharmacy and 200 hours0.00231 days <br />0.0556 hours <br />3.306878e-4 weeks <br />7.61e-5 months <br /> of classroom and laboratory training, as required by 10 CFR 35.55(b)(1) and is able to independently fulfill the radiation safety-related duties as an authorized nuclear pharmacist.
Nuclear Pharmacy or Medical Facility License/Permit Number Name of Preceptor Signature Date I am an Authorized Nuclear Pharmacist for Telephone Number Second Section Complete the following for preceptor attestation and signature:
NRC FORM 313A (ANP) (01-2020)