The Australian Radiation Protection and Nuclear Safety Agency
National Diagnostic Reference Level Service
Registration Process – Step 1 – Facility and Radiologist’s Details
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Step 1: Facility and Radiologist’s Details
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Step 2: Add Scanners > Step 3: Add Contact
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Please complete all fields marked with an asterisk
*
Facility Details
Facility Name
*
Facility LSPN
*
Facility Type:
*
--Please Select--
Public Clinic in a Public Hospital
Private Clinic in a Public Hospital
Private Clinic in a Private Hospital
Private Clinic
Address
Address Line 1:
*
Address Line 2:
Address Line 3:
Town/Suburb
*
Country
*
--Please Select--
Australia
New Zealand
State
*
--Please Select--
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Other
Postcode
*
Radiologist’s Details
Title
*
--Please Select--
Associate Professor
Dr
Miss
Mr
Mrs
Ms
Other
Professor
If Other, Specify
Family Name
*
First Name
*
Middle Name
Phone(Office)
*
Phone(Mobile)
Fax
Email
*
*
By ticking this, I hereby certify that I have read the disclaimer statement found at the bottom of this website. The Contact details within this application and all information submitted in connection with this online application is true and correct. I agree that ARPANSA may verify any of the information submitted in support of this application, and I understand that I am under a continuing obligation to advise the National Diagnostic Reference Level Database of any changes which may occur after application submission. I further certify that this contact person has the right to receive information on behalf of the nominated facility. I understand and agree that the omission, misrepresentation, or concealment of any significant fact in any statement may be considered sufficient reason for legal action against the facility which will be executed to the full extent of the law.
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