New Hampshire Code of Administrative Rules
Mirt - Board of Medical Imaging and Radiation Therapy
Chapter Mirt 300 - REQUIREMENTS FOR LICENSURE
Part Mirt 302 - APPLICATION PROCEDURE
Section Mirt 302.04 - Required Documents

Universal Citation: NH Admin Rules Mirt 302.04

Current through Register No. 12, March 21, 2024

Applicants for initial licensure as a limited x-ray machine operator, medical imaging professional, or radiation therapist shall provide, or arrange for the board to receive, the following documents supporting their applications:

(a) A recent passport size, 2" x 2", original head-shot photograph;

(b) On a separate sheet, a detailed report of the relevant circumstances if any of the answers to questions described in Mirt 302.02(f)(1)-(7) on part one of the application form is in the affirmative;

(c) On a separate sheet, a detailed report of the relevant circumstances if any of the answers to questions in Mirt 302.02(i)(1)-(5) on part 2 of the application form is in the affirmative;

(d) Unless the information sought is available only on a website, an official letter of verification sent directly to the board from every jurisdiction which has issued a license or other authorization to practice stating whether:

(1) The license or other authorization is or was, during its period of validity, in good standing; and

(2) Whether any disciplinary action was taken against the license or other authorization to practice;

(e) A photocopy of the applicant's national certification card bearing the appropriate certification for the applicant's modality, which shall be verified upon receipt;

(f) The documents required for the criminal history records check pursuant to RSA 328-J:7-a shall include either:

(1) The documents required for a criminal background check run by the NH state police, including:
a. A criminal history record release form, also known as form DSSP from the department of safety, available at https://www.nh.gov/safety/divisions/nhsp/forms.html;

b. A completed fingerprint card or submission of live scan documentation. A fingerprint card may be obtained by contacting the board offices. Live scan site locations may be found on the department of safety's website at https://www.certifixlivescan.com/category/fingerprinting-service-locations/new-hampshire/; and

c. The fee, as required by the department of safety; or

(2) For any individual actively serving in any component of the Department of Defense, documentation that the individual has received military security clearance.

(g) A resume presenting a chronologically organized account of the applicant's paid and voluntary work experience in the applicant's field of medical imaging or radiation therapy for the prior 5 years. The period of each separate experience shall be designated by its beginning and end dates, and the city and state of each experience shall be listed; and

(h) Proof of education, which shall be:

(1) For sonographers:
a. If having completed an educational program on or before December 31, 2019, a photocopy of a currently valid certificate issued by Cardiovascular Credentialing International (CCI); and

b. If having completed an educational program after December 31, 2019, either a letter signed by the applicant's supervisor stating that the applicant has successfully completed a program of on-the-job training, or an official transcript as required under (2)b. below; and

(2) For all other licensees:
a. If first employed in the field before January 1, 2017, either a letter signed by the applicant's supervisor stating that the applicant has successfully completed a program of on-the-job training, or an official transcript as required under

b. below; and b. If first employed in the field after January 1, 2017, an official transcript showing successful completion of one of the courses of study required by RSA 328-J:11, I(c), RSA 328-J:11, II(c), RSA 328-J:11, III(c), RSA 328-J:11, IV(c), RSA 328-J:11, V(c), or RSA 328-J:11, VI(c).

Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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