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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HEA5139
for the current year.
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.
FAQ
Q: What is HEA5139?
A: HEA5139 is the application for self-referral screening utilizing radiation generating equipment in the state of Ohio.
Q: What does the application involve?
A: The application involves self-referral screening using radiation generating equipment.
Q: Who can use the application?
A: Any individual in Ohio who wants to undergo self-referral screening using radiation generating equipment can use this application.
Q: What is self-referral screening?
A: Self-referral screening is a process where individuals can request and undergo certain medical tests or screenings without a referral from a healthcare provider.
Q: What does 'radiation generating equipment' refer to?
A: Radiation generating equipment refers to devices that emit radiation, such as X-ray machines or CT scanners.
Q: What is the purpose of this application?
A: The purpose of this application is to allow individuals in Ohio to request and undergo self-referral screening using radiation generating equipment.
Form Details:
- Released on June 1, 2020;
- 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 printable version of Form HEA5139 by clicking the link below or browse more documents and templates provided by the Ohio Department of Health.
Download Form HEA5139 Application for Self Referral Screening Utilizing Radiation Generating Equipment - Ohio
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