Form HEA5139 Application for Self Referral Screening Utilizing Radiation Generating Equipment - Ohio

What Is Form HEA5139?

This is a legal form that was released by the Ohio Department of Health - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on May 1, 2022;
• The latest edition provided by the Ohio Department of Health;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a fillable version of Form HEA5139 by clicking the link below or browse more documents and templates provided by the Ohio Department of Health.