X-ray Registration Forms

Facilities in Minnesota with ionizing-radiation producing x-ray equipment must be registered with the Minnesota Department of Health, Radiation Control, X-ray Unit. X-ray fees cover the costs of running a statewide registration, compliance and education program, as well as to assure that the health and safety of the workers and general public are protected. The fees are approved by the legislature and are mandated under Minnesota Statute 144.121.

Information Notice - Facility Registration (PDF: 98KB/2pages)
X-ray Program Responsibilities (PDF: 95KB/2pages)

Initial Registration
(new facility or new/transfer of ownership)

This form should be completed by facilities not currently registered with MDH, facilities currently registered but under new ownership, or a satellite office that has not been registered. New facilities obtaining x-ray equipment must pay fees and certify their facility prior to first use of x-ray equipment.

Additional Registration
(new equipment or replacement console and/or tube at registered facilities)

For facilities that are currently registered with MDH who have additional or console and/or tube replacement equipment. There is no fee for replacement equipment, regardless if equipment is not the same type. Facilities already registered with MDH, with new or replacement equipment, must notify MDH within 30 days and prior to first use of the equipment.

X-ray Machine Equipment Transfer
(transfer equipment between facilities under same ownership)

For facilities that would like to transfer x-ray equipment from one of their registered locations to another. Equipment must be currently registered within the last 6 months. If registration is not current, please fill out the Additional Registration form and pay applicable fees.

Change in Facility Information

For facilities that have a change in facility information: equipment changes, facility name, address change, administrator or RSO change, Tax Id changes, etc., fill out the form below.

For questions, comments or feedback regarding the MDH X-ray Program, please email health.xray@state.mn.us or call 651.201.4545.

Updated Friday, October 02, 2015 at 11:30AM