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APPLICATION FOR DELAWARE RADIOGRAPHY CERTIFICATE
DENTAL, LIMITED SCOPE MEDICAL, OR BONE DENSITOMETRY LICENSURE
Complete and return this application with a non-refundable/non-transferable application fee toward obtaining a radiography
certificate. See below for specific examination fees. Make check or money order payable to the Delaware Office of Radiation
Control and mail to the following address. Neither cash nor credit card can be accepted.
Allow a minimum of three (3) weeks for processing. Mail to:
Delaware Office of Radiation Control
417 Federal Street
Dover, DE 19901
(PLEASE TYPE OR PRINT LEGIBLY)
NAME: ________________________________________________
PHONE: _________________________________
ADDRESS: _________________________________________________________________________________________________
CITY: _____________________________________________ STATE _____________ ZIP:________________________________
SOCIAL SECURITY NUMBER: _____________________________________ DATE OF BIRTH: __________________________
==============================================================================================
STATE EXAMINEES: DENTAL RADIATION TECHNICIANS
APPLICATION FEE: $ 0.00 check or money order made payable to the Delaware Office of Radiation Control.
___ Dental Radiation Technician
I have enclosed a photocopy of the letter from
DANB with my passing score on the DDRT examination. YES ______ NO ______
____I certify that I am enrolled at a technical vocational
high school in Delaware, and request the application
fee be waived . I have enclosed a letter from my high
Dental Assisting Program Director:Yes ____ NO___
STATE EXAMINEES: LIMITED SCOPE MEDICAL RADIATION TECHNICIANS
EXAMINATION FEE: $1 0.00 (includes $ 0 application fee) made payable to the Delaware Office of Radiation Control.
(Your name, address, birth date and social security number will be provided to the American Registry of Radiologic Technologists (ARRT)
for processing, to determine exam date).
I plan to take the following examination(s), (please check all specialties that apply):
___ Chest
___ Extremities ___ Skull ___Spine ___ Podiatry
__X__ Core Medical Exam (required for limited scope medical)
STATE EXAMINEES: BONE DENSITOMETRY RADIATION TECHNICIANS
EXAMINATION FEE: $1 0.00 (includes $ 0 application fee) made payable to the Delaware Office of Radiation Control.
(Your name, address, birth date and social security number will be sent to the American Registry of Radiologic Technologists for processing
to determine exam date).
____ Bone Densitometry Operators Exam (for those seeking to practice bone densitometry ONLY)
Have you been convicted of a felony within the past ten years? YES_______ NO _______ If yes,
I certify that I have read and understand my mandatory obligation to report in writing to the Board of Medical Licensure
and Discipline any instance of unprofessional conduct and/or unsafe practice conditions by a medical practitioner
within 30 days of becoming aware of such conduct/conditions
to immediately make an oral report to the
Department of Services for Children, Youth and Their Families knowledge or suspicion of child abuse or neglect:
YES_____ NO_____
I certify that the information provided is true to the best of my knowledge. I have included
in check or money
order made payable to the Delaware Office of Radiation Control for each certificate requested: YES __NO ___
___________________________________________
APPLICANT’S SIGNATURE
______________________________
DATE
DELAWARE DIVISION OF PUBLIC HEALTH OFFICE OF RADIATION CONTROL
417 FEDERAL STREET DOVER DELAWARE 19901
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APPLICATION FOR DELAWARE RADIOGRAPHY CERTIFICATE
DENTAL, LIMITED SCOPE MEDICAL, OR BONE DENSITOMETRY LICENSURE
Delaware Office of Radiation Control
417 Federal Street
Dover, DE 19901
PLEASE PRINT OR TYPE LEGIBLY
NAME: __________________________________________________
PHONE: ______________________
SOCIAL SECURITY NUMBER: _________________________________ DATE OF BIRTH: _________________
=======================================================================================
SELECT CERTIFICATE TYPE REQUESTED
Radiation Technician certificates are issued with the following legal titles, after recieving proof of the applicant passing the
state examination. On page 1, check off the category for which you are requesting certification.
Dental Radiation Technician (State DDRT Exam or DANB RHS Exam)
Medical Radiation Technician, Limited Scope of Practice (State Limited Scope Exam, ARRT)
Medical Radiation Technician, Bone Densitometry Only (State Bone Densitometry Operator Exam, ARRT)
DUTY TO REPORT
1. To obtain a license in Delaware, you must certify that you understand that you have a mandatory
obligation to file a written report with the Board of Medical Licensure and Discipline within 30 days of becoming
aware of or having any reason to believe that a medical practitioner other than yourself is (or may be) guilty of
unprofessional conduct as defined in 24 Del. C. §1731 OR that he/she is (or may be):
medically incompetent
mentally or physically unable to engage safely in the practice of medicine
excessively using or abusing drugs including alcohol.
I certify that I have read and understand the provisions of 24 Del. C. §1730, 24 Del. C. §1731 and 24 Del. C.
§1731A above, and that I understand my duty to report. Yes _____ No_____
2. To obtain a license in Delaware, you must certify that you understand that you have a mandatory
obligation to make an immediate oral report to the Department of Services for Children, Youth and Their Families
if you know of, or you suspect, child abuse or neglect under Chapter 9 of Title 16 and to follow up, with any
requested written reports.
I certify that I have read and understand the provisions of 16 Del. C. §903 above, and that I understand
my duty to report. Yes_____ No_____
I certify that the information provided is true to the best of my knowledge. YES ___NO ___
_____________________________________
APPLICANT’S SIGNATURE
_________________________
DATE
DELAWARE DIVISION OF PUBLIC HEALTH OFFICE OF RADIATION CONTROL
417 FEDERAL STREET DOVER DELAWARE 19901
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INSTRUCTIONS FOR COMPLETING FORM ORC R16-S
APPLICATION FOR STATE RADIOGRAPHY CERTIFICATE
Dental, Bone Densitometry, Medical Limited Scope
Item
Name and Address
Social Security Number
Date of Birth
State Medical Radiation Technician Certificate
Application Fees
First-Time Application Fee Waiver for Students
enrolled in a technical, vocational high school
dental assisting program
Examination Fees
ORC-R16S
Instructions/Definitions
Submit application with current name and mailing
address. If your name has changed, proof is required,
eg. copy of marriage license, judgement of divorce, or
court papers. Applicant is obligated to notify the Office
of Radiation Control when name or address changes
utilizing ORC Form R16-A, all forms are available on the
ORC webpage:
http://www.dhss.delaware.gov/dhss/dph/hsp/orc.html
A social security number is required for purposes of
positive identification. Applicants who do not possess
a social security number may submit an official
notarized affidavit with their application for radiation
technologist/technician certification. Either a social
security number, OR the notarized affidavit must be
submitted in order for the application to be deemed
complete. A link to the Delaware affidavit form is
posted on the ORC webpage (see link above).
A date of birth is required for purposes of positive
identification.
Individuals must specify which type of state
radiography certificate they are applying for:
• Dental
• Bone Densitometry, or
• Medical Limited Scope
All applicants for a state radiography certificate must
submit an application fee in the amount of $50.00 in
check form, except for technical, vocational high school
students applying for the first time, as described
below.
Students enrolled at a technical, vocational high school
dental assisting program located in Delaware may have
their first application for radiography certificate fee
waived (one time only), if they enclose a letter
affirming their enrollment from their high school Dental
Assisting Program Director. The letter is submitted in
place of check.
In addition to the application fee, examination fee of
$100.00 must be submitted in check form with
applications for the following exams administered for
Delaware by the American Registry of Radiologic
Technology (ARRT):
• B o n e D en sito m etr y Operator
• Medical Limited Scope
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Item
Dental
INSTRUCTIONS FOR COMPLETING FORM ORC R16-S
APPLICATION FOR STATE RADIOGRAPHY CERTIFICATE
Dental, Bone Densitometry, Medical Limited Scope
Instructions/Definitions
Individuals applying for a Dental radiography certificate
must either:
• Pass the Delaware Dental Radiologic
Technology (DDRT) Exam administered for
Delaware by the Dental Assisting National
Board (DANB), OR
• Present proof of having passed the Radiological
Health & Safety (RHS) Exam given by the
Dental Assisting National Board (DANB).
In both cases, applicants apply directly to DANB to
schedule and pay for their examination, and will
receive their exam results directly from DANB. After
they receive their official, final results, then they may
apply to the state for certification using this form.
ONLY OFFICIAL, FINAL test results will be accepted with
the application for radiography certificate. If
preliminary test results are submitted, the application
will be returned to the applicant.
Bone Densitometry
Medical Limited Scope
To obtain a radiography certificate, individuals applying
for a Bone Densitometry radiography certificate must
submit examination AND application fees, and:
• Take and Pass the Bone Densitometry
Operators Exam administered for Delaware by
the American Registry of Radiologic
Technology (ARRT), OR
Submit an application fee ONLY and:
• Present proof of having passed the bone
densitometry examination given by the
International Society of Clinical Densitometry
(ISCD)
To obtain a radiography certificate, individuals applying
for a Medical Limited Scope Certificate must submit
examination AND application fees, and then:
• Take and Pass the Medical Limited Scope Exam
administered for Delaware by the American
Registry of Radiologic Technology (ARRT).
The Office of Radiation Control provides the applicant’s
information to the ARRT. The ARRT will contact the
applicant to schedule and provide details about the
testing facilities. The ARRT transmits official exam
results to the Office of Radiation Control, who then
ORC-R16S
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Item
INSTRUCTIONS FOR COMPLETING FORM ORC R16-S
APPLICATION FOR STATE RADIOGRAPHY CERTIFICATE
Dental, Bone Densitometry, Medical Limited Scope
Instructions/Definitions
contacts the applicant via U.S. Postal Service. If a
passing score was received, the applicant receives their
certificate. If a passing score is not received, the
applicant receives a notification letter from the Office
of Radiation Control.
Felony Conviction
Duty to Report
Review of Delaware Code is Mandatory
ORC-R16S
The radiation technologist/technician regulations
specify a list of offenses that can be grounds for
disciplinary action, and which can be the basis for
refusal of an application for certification. The list
includes having been convicted of a felony. If the
applicant has been convicted of a felony within the
past ten years, they must attach a copy of court
documents which include the original charges, and
disposition (case closed) papers.
Since 2011, applicants applying for licensure as health
care workers are required to certify that they have
read and understand their mandatory obligation to
report within 30 days of becoming aware or having any
reason to believe that a medical practitioner may be
guilty of unprofessional conduct, of if they know of or
suspect child abuse or neglect.
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The full text of Delaware Code citations relating to Duty to Report Requirements for health care
providers is available online at:
http://delcode.delaware.gov/.
TITLE 16
Health and Safety
Regulatory Provisions Concerning Public Health
CHAPTER 9. ABUSE OF CHILDREN
Subchapter I. Reports and Investigations of Abuse and Neglect; Child Protection
Accountability Commission
§ 903. Reports required.
AF
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Any person, agency, organization or entity who knows or in good faith suspects child abuse or neglect
shall make a report in accordance with § 904 of this title. For purposes of this section, "person" shall
include, but shall not be limited to, any physician, any other person in the healing arts including any
person licensed to render services in medicine, osteopathy or dentistry, any intern, resident, nurse, school
employee, social worker, psychologist, medical examiner, hospital, health care institution, the Medical
Society of Delaware or law-enforcement agency. In addition to and not in lieu of reporting to the Division
of Family Services, any such person may also give oral or written notification of said knowledge or
suspicion to any police officer who is in the presence of such person for the purpose of rendering
assistance to the child in question or investigating the cause of the child's injuries or condition.
16 Del. C. 1953, § 1002; 58 Del. Laws, c. 154; 60 Del. Laws, c. 494, § 1; 72 Del. Laws, c. 179, § 4; 77
Del. Laws, c. 320, § 1.;
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§ 904. Nature and content of report; to whom made.
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Any report of child abuse or neglect required to be made under this chapter shall be made to the
Department of Services for Children, Youth and Their Families. An immediate oral report shall be made
by telephone or otherwise. Reports and the contents thereof including a written report, if requested, shall
be made in accordance with the rules and regulations of the Division, or in accordance with the rules and
regulations adopted by the Division.
16 Del. C. 1953, § 1003; 58 Del. Laws, c. 154; 60 Del. Laws, c. 494, § 1; 64 Del. Laws, c. 108, §§ 4, 11;
77 Del. Laws, c. 320, § 2.;
TITLE 24
Professions and Occupations
CHAPTER 17. MEDICAL PRACTICE ACT
Subchapter IV. Disciplinary Regulation; Proceedings of the Board
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§ 1730. Duty to report unprofessional conduct and inability to practice medicine [Effective Jan. 30, 2011]
(a) Every person to whom a certificate to practice medicine is issued has a duty to report to the Board if
that person is treating professionally another person who possesses a certificate to practice medicine for a
condition defined in § 1731(c) of this title, if, in the reporting person's opinion, the person being treated
may be unable to practice medicine with reasonable skill or safety. The reporting person shall provide the
Board with a written report which includes the name and address of the person being treated, the exact
condition being treated, and the reporting person's opinion of whether or not action should be taken under
§ 1731 of this title. A person reporting to the Board or testifying in any proceeding as a result of making a
report pursuant to this section is immune from claim, suit, liability, damages, or any other recourse, civil
or criminal, so long as the person acted in good faith and without gross or wanton negligence; good faith
being presumed until proven otherwise, and gross or wanton negligence required to be shown by the
complainant.
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(b)(1) Every person to whom a certificate to practice medicine is issued and health care facility as
defined in § 1740 of this title has a duty to report to the Board within 30 days:
a. Any change in hospital privileges; and
AF
b. Any disciplinary action taken by a medical society against that person; and
c. Any reasonably substantiated incidents involving violence, threat of violence, abuse, or
neglect by a person toward any other person.
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(2) Every person certified to practice medicine in this State shall report to the Board within 30
days any civil or criminal investigation in any jurisdiction which concerns that person's certification or
license or other authorization to practice medicine. The Board may require an applicant to provide
sufficient documentation to enable the Board to determine whether to investigate, pursuant to § 1732 of
this title, or whether there are grounds for discipline under § 1731(b) of this title.
D
(c) Every person to whom a certificate to practice medicine is issued has a duty to report to the Board,
within 60 days, all information concerning medical malpractice claims settled or adjudicated to final
judgment, as provided in Chapter 68 of Title 18, and, within 30 days, all information required to be
reported under § 1731A(f) of this title.
(d) Every person to whom a certificate to practice medicine is issued has a duty to report, within 30
days of the day each such person becomes aware, of the existence of a report to the Department of
Services for Children, Youth and Their Families under Chapter 9 of Title 16 against that person
concerning child abuse or neglect or a report to the Division of Long-Term Care Residents Protection
under Chapter 85 of Title 11 against that person concerning adult abuse, neglect, mistreatment, or
financial exploitation.
60 Del. Laws, c. 462, § 1; 70 Del. Laws, c. 186, § 1; 71 Del. Laws, c. 102, §§ 8, 9; 75 Del. Laws, c. 141, §
1; 77 Del. Laws, c. 320, § 9; 77 Del. Laws, c. 325, § 1; 77 Del. Laws, c. 460, § 2.;
§ 1731A. Duty to Report.
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(a) Any person may report to the Board information that the reporting person reasonably believes
indicates that a person certified and registered to practice medicine in this State is or may be guilty of
unprofessional conduct or may be unable to practice medicine with reasonable skill or safety to patients
by reason of mental illness or mental incompetence; physical illness, including deterioration through the
aging process or loss of motor skill; or excessive use or abuse of drugs, including alcohol. The following
have an affirmative duty to report, and must report, such information to the Board in writing within 30
days of becoming aware of the information:
(1) All persons certified to practice medicine under this chapter;
(2) All certified, registered, or licensed healthcare providers;
(4) All healthcare institutions in the State;
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(3) The Medical Society of Delaware;
(5) All state agencies other than law-enforcement agencies;
AF
(6) All law-enforcement agencies in the State, except that such agencies are required to report
only new or pending investigations of alleged criminal conduct specified in § 1731(b)(2) of this title, and
are further required to report within 30 days of the close of a criminal investigation or the arrest of a
person licensed under this chapter.
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(b) If a person certified to practice medicine in this State voluntarily resigns from the staff of a
healthcare institution, or voluntarily limits that person's own staff privileges at a healthcare institution, or
fails to reapply for hospital or staff privileges at a healthcare institution, the healthcare institution and the
person shall promptly report in writing such conduct to the Board if the conduct occurs while the person
is under formal or informal investigation by the institution or a committee thereof for any reason related
to possible unprofessional conduct or possible inability to practice medicine with reasonable skill or
safety to patients by reason of mental illness or mental incompetence; physical illness; or excessive use or
abuse of drugs, pursuant to § 1731 of this title.
D
(c) Upon receiving a report pursuant to subsection (a) or (b) of this section, or on its own motion, the
Board shall investigate any evidence which appears to show that the person reported is or may be guilty of
unprofessional conduct or may be unable to practice medicine with reasonable skill or safety to patients
by reason of mental illness or mental incompetence; physical illness; or excessive use or abuse of drugs,
pursuant to § 1731 of this title.
(d) When an investigation is necessary pursuant to subsection (c) of this section, the Executive
Director, with the approval of the assisting Board members who must be or must include a physician and
a public member when the investigation relates to the quality of medical care provided by a physician or
to the competency of a physician to engage safely in the practice of medicine, has the authority to inquire
from any organization which undertakes physician peer review or physician quality assurance evaluations
whether or not there has been any peer review, quality assurance, or similar process instituted involving
the physician under investigation. The Executive Director may, by subpoena, compel the production of a
list of the medical records reviewed during the peer review process, a list of the quality assurance
indicators, and/or a list of other issues which were the basis for the peer review, quality assurance, or
similar process. The lists produced must identify each item with a unique medical identifier to replace the
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patient's name and specific identifying information. If necessary, after receiving the lists the Executive
Director may, by subpoena, compel the production of the relevant medical records. However, the
individual, hospital, organization, or institution shall remove the patient's name and specific identifying
information from the records prior to complying with the subpoena. If, after having reviewed the records
produced, an assisting physician Board member and an assisting public Board member consider it
necessary, the Executive Director may, by subpoena, compel the production of the patient's name. The
Board shall take reasonable steps to protect the identity of the patient in so far as such protection does not,
in the opinion of the Board, adversely affect the Board's ability to protect the public interest. An
individual, hospital, organization, or institution that furnishes information to the Board pursuant to a
subpoena issued pursuant to this subchapter with respect to any patient is not solely by reason of
furnishing the information liable in damages to any person or subject to any other recourse, civil or
criminal.
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(e) The Board shall promptly acknowledge all reports received under this section. Individuals or
entities reporting under this section must be promptly informed of the Board's final disposition of the
reported matters.
AF
(f) Malpractice insurance carriers and insured persons certified to practice medicine in this State shall
file with the Board a report of each final judgment, settlement, or award against the insured persons. A
person not covered by a malpractice insurance carrier shall also file a report with the Board. A report
required to be filed under this subsection must be made to the Board within 30 days of a final judgment,
settlement, or award.
(g) An individual, institution, agency, or organization required to report under this section who does so
in good faith is not subject to civil damages or criminal prosecution for reporting.
D
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(h) The Executive Director shall initially review every report made to the Board under this subchapter.
The Executive Director may defer the investigation of a report pending a reported licensee's evaluation
and treatment for substance abuse or for physical or mental illness, provided sufficient safeguards exist to
protect the licensee's patients and the public. Safeguards may include a verifiable, voluntary cessation of
the practice of medicine or a limited or monitored practice. Upon completion of the reported licensee's
evaluation and treatment, the Executive Director may resume investigation of the report pursuant to the
requirements of this chapter. If the Executive Director determines that a deferral is warranted, the case
shall be summarized and placed before the Board for its information.
(i) Pursuant to the authority conferred herein and by § 1713 of this title, the Board shall have the
authority to impose a fine, not to exceed $10,000 for the first violation, and not to exceed $50,000 for any
subsequent violation, on any person, any healthcare provider, any healthcare institution, and the Medical
Society of Delaware for violation of any duty imposed by this chapter, and said fine shall be imposed
pursuant to the procedures of this chapter.
(j) Upon receiving a complaint involving potential criminal conduct, the Board shall promptly report
the complaint to appropriate law-enforcement agencies, including the Delaware Department of Justice.
67 Del. Laws, c. 159, § 1; 70 Del. Laws, c. 186, § 1; 71 Del. Laws, c. 102, § 15; 75 Del. Laws, c. 141, § 1;
75 Del. Laws, c. 358, § 2; 77 Del. Laws, c. 319, §§ 7, 8; 77 Del. Laws, c. 321, § 2; 77 Del. Laws, c. 325,
§§ 7-9.;
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