X-ray Device Inventory Update

MSDH Registration Number

Located on the Notice of Registration issued by the MS Department of Health

Primary Registrant Name

May be listed on the Notice of Registration as an individual or a campus unit.

Responsible Party

Who oversees the equipment within the department?

X-ray Tube Manufacturer

X-ray Tube Serial Number

Device Manufacturer

Device Serial Number

Date of Purchase

If known

Building

Where is the machine located?

Room

File Upload

Please provide copies of any relevant information. Examples include: MSDH Notice of Registration, x-ray operator licensure, LXMO certificates, service or preventative maintenance documentation, device certifications, images of the equipment and serial number plate, etc.

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