Sponsored yera •• Presentation Sisters Sacred Heart · yera •• Sacred Heart Hospital...
Transcript of Sponsored yera •• Presentation Sisters Sacred Heart · yera •• Sacred Heart Hospital...
•• yera Sacred Heart Hospital
December 5,2011
U.S. NRC Region IV Texas Health Resources Tower Licensing Section 612 E. Lamar Blvd., Suite 400 Arlington, TX 76011-4125
Ref: License # 40-01683-01
Gentlemen:
Sponsored by the Benedictine and Presentation Sisters
501 Summit Yankton, SD 57078-3899 (605) 668-8000
RECEIVED
DEC 1 3 2011
IDNMS
Please amend our license to include Ralph Tullo MD who is currently authorized to perform 35.100 and 200 studies, also to perform procedures permitted under section 35.300. We are attaching his Florida license wherein he is identified to perform procedures requiring written directive,
Please feel free to contact our Radiation Safety Officer S. Guru Prasad, Ph.D. at 847-570-1535 or 847 921-3462 if you have any questions regarding this request.
Sincerely,
Barry Graham, MD VP Medical Affairs
/h576535
: STATE OF FLORIDA DEPARTMENT OF HEALlH
BUREAU OF RADIATION CONTROL
RAD~OACTIVE MATERIALS LICENSE . SUPPLEMENTAL SHEET
CENTRAL FL.ORIDA REGIONAL HOSPITAL, INC. d/b/a Central Florida Regional Hospital 1401 West Seminole'Boulevard : Sanford, FL 32771
... " ,. ,.
With reference to correspondence d81ted July 12~ 2011, State.of, Florida Radioactive Materials License Number 2490-1 is hereby.amended .. l,' ... ·, :,.:;i, . _',. .... \
12.
''''', ~
." I "
.:'.. , ., - " . ... ., ..... :':,:, ¢dNt)l:rrqNS:-'~.' .,. ·-'~.:·~,t:;·;: ,;,:~:;::;':~,:. ",i::.'· ... I ','
A. ',' ;,
The fotlowing individuals or persons under th~ir· supervision. are. authorized for the materials and u·sesas irldic;a~ed::, ' .. ',<: . . .. . ... : ... ,. ... :
64E-S.630(2), (4) and 64E:.-5:63? .:::... ..' ::· .. :.Ste¥~·n:.~;.~:~~ter.· Nl.D. ' ... ' ..: ,': ,..:. .'. ;:".. .'.: ::.:.:'<:. ·'~~o,h..np~·~ ~.ooper, M p.
64E-5.632
64E-5.632(3) and (4)
64E-5.626(1), (2). 64E-5.627(1), ~(2) and 64E~5.630 (2). (3)
,
64E-5.626(1), (2) and 64E-5,627(1). (2)
Sholmo Liebowich, M.D. Reuven Porges. M.D. Ajay Doddapaneni, M.D.
Jorge Gomez, M.D. Sharon Anderson, M.D.
License Number; 2490-1 Amendment No.: 61
(58]
Control Number: 20110713-1181
LICENSEE COpy
Page 1 of 3 page( s) Expiration Date: 6/3012.014 a
11 ~).7.nf:}.n'f1 A80'10raVH
RiO R3
RiO
RiO RiO
RiO RiO R10
RiO RiO RiO RiO RiO
R10 RiO RiO
RiO
RiO
R10 RiO RiO RiO
RiO RiO RiO
RiO RiO
64E-5 Florida Administrative Code 64E-S.626 *"'-'=: J J '
SUBPARTC UPTA;KE) DILUTION, AND EXCRETION
i
64E-5.626 Use of RadimarmaceuticalS fQr Uptake, Dilution, or Excretion Studies. ((§ltHW!UIt.Ui3!j,r?F A licensee is allowed to use any p~~g~t{giiradioactive material in a radiopharmaceutical for a d use urements of uptake. dilution, or excretion for medical ~se !
(1 )
RiO (2) RiO
RiO RiO RiO
RiO R10 RiO RiO
s:-nn·.-r 111':).7.01':).017 li.8010rQlfH
Q10 R10 R10
R10
R10
R10 R10 R10 R10
R10 R10 R10
R10 R10 R10 R10
R10 R10 R10
~10
"
(1)
" '
64E-5 Florida Administrative Code 64E-5.627 "d W
(a) Obtained from a manufacturer or pharmacy licensed as specified in; subsection 64lE-5.21 0(10), F.A.C., or in equivalent U.S. Nuclear I Regulatory Ccimmission,or Agreement State regulations; or I
(b) I I
VI- 36
11 P,).7.0r.l.0'!7 X80'lOrQlfB: 80:rT TTOZ-90-J~Q
R10
R10 R10 Ria R10
R10 R10 RiO
R10 R10
R10 RiO
RiO RiO RiO
Ria R10 RiO RiO
R10 Ria R10
R10
RiO
RiO R10 R10
R10 RiO RiO
RiO R10 RiO
RiO RiO R10
64E-5 _nt
(2)
11SJ.Z08l.O'17
!Florida Administrative Code 64E~5.627 fo
vr-37
1t80'lOrmm
11 5 7 8 lift, - ,
60:r.r r.TOZ-90-0SG
R10 R10 R10
RiO R10 RiO R10
R10 .R10 RiO
R10
R10
R10 RiO R10
R10 R10
.'- R10
R10 R10
R10 R10 R10
R10
R10
. , I
64E-S :Florida Administrative Code 64E-5.627 "
W~@i\m@ijg Authority: 404.022. 404.051.404.061,404.071, 404.081, 404.141. F.S. I
Law ImplemGnted; 404.022.404.051(1). (4). (:5). (6). (8). (9). (10). (11). 404,061(2,): ,3~'",::lH,~"~?t(.1),,,194,081, 404,141, F.S. History: New 8-25-91. Amendt;)d 5-12-93. Formerly 10D-91.735, Amended 8-6-01ij '" ',. \;i~\,,\!,~ . !
I i
VI ~38
qoo',.:r 118LZ08Wv Ji.80'lOIa'\f~ IT:Tl llOZ-90-0~a
64E-5 florida Administrative Code 64E-5.630 .. ~., F It .... rl
SUBPART E . RADIO~HARMACEUTJCALS FOR THERAPY
64E·5.~3.0" ·'.Use, of Radiopharmaceuticals for Th RiO ioacti. ateriGiI in a radio harmaceutical R10 and for a therapeutic medical use R10
R10 (1) RiO R10
RiO RiO R10
RiO R10 RiO RiO
R10 RiO R10
R10
R10
RiO RiO
R10 R10 R10
RiO R10
R10 (2) R10
R10 RiO R10
RiO RiO
. R10 "riO
VI-42 ~h576535
WOOd li.80'10 I mn! ff:ff ffOZ-90-0sa
Q10 RiO RiO
RiO
RiO
R10 RiO
RiO R10 RiO
RiO RiO
RiO RiO
RiO RiO RiO
-.Ri0 ~10 RiO RiO
R10 RiO RiO
R10
RiO
RiO RiO
RiO RiO R10
RiO RiO
. -R10 .~1 0 RiO
64E-5 Florida Administrative Code 641:: .. 5,630 .
V/-43
Ann"...r .li.80'10rmm
600'd T\f.LOJ.
RiO RiO RiO R10
RiO RiO R10
RiO
RiO
RiO RiO
R10 RiO
RiO
R10
R10 RiO RiO RiO RiO
RiO
RiO
RiO RiO
R10 RiO
.. Florida Administrative Code 64E-5.631 7
I
BM.l~m~~i1i!9' Authority~ 404.022, 404.051, 404.061, 404.071, 404.081, 404.141, F.S. U,lW Implomented: 404.022, 404.051(1), (4);: (5), (6), (8), (9), (i0). (11), 404.061(2 '. ~3~, 404,P?,1P)!,.494.081 , 404.141, F.S. History: New 8-25-91, Amended 5-12-93, Formorly 100-91.739, Amended 8-6-01~ iN; . .¥i~ '~!.I..".
(1 )
(2)
(3)
(4)
i SUBPART F
SEAf:.ED SOURCES FOR DIAGNOSIS
Iodine 125 as a sealed source in a device for bone mineral analysis;
Iodine 125 as a sea~ed source in a portable device for imaging; I
Gadolinium 153 as i'jl sealed source in a device for bone mineral analysis; :,
Americiul)l 241 as a:sealed source in a device for bone mineral anaIYSis~;t~] . I
R1 0 f&.l€t(ri~~if.1g Authority: 404.022, 404.051, , 404.071, 404.081, 404.141, F,S. : L~w Impiem<lnted: 404.022, 404.051 (1), (4),.(9).. \~}. (8~"?0), (11), 404.061 (2), (3), 404.071(1), 404.081,404.141:. F.S.
RiO History: New 8-25·91, Formerly 10D-91.743.00;W8~~~~. :
VI-44 No. 5 7 6.5 3 5
600'd TT8.!.2:08Wv li.8010 I mii:! v1:11 1 T02:-90-830
AveraFi Sacred Heart Hospital
501 Summit Street Yankton, SD 57078-3855
RECE\\lEO DEC 1 3 IQn
ONMS
Avera~ Sacred Heart Hospital
501 Summit Yankton, SD 57078-3899
TO:
U.S. NRC Region IV Texas Health Resources Tower Licensing Section 612 E. Lamar Blvd., Suite 400 Arlington, TX 76011-4125
/~-0·-T- -~ v~:" //J" ,~ \~~ () 7 3 -99
0 (?
/ G) J _ r:.<
(DEC - 8 20ll
\ " " . ". ,--,~/-~
,/.j~~,-
I ~
,:,\~:\\O.s POs", I 1~'C:::r,
z :::>
$, 01 d-))OO (12 1M 'r. !lA~U1
.000"1292736 DEC0720'11 '.': MAILED FROM ZiP CODE 57078
lD
Cf)
U")
c.o 1'--
lD
:iiil
DEC 13 2011 This is to acknowledge the receipt of your letter/application dated· DATE
DEC - 5 2011 , and to inform you that the initial processing, which includes an administrative review, has been performed.
·~'~here were no administrative omissions. Your application will be assigned to a technical V ~~viewer. Please note that the technical review may identify other omissions or require additional information.
D Please provide to this office within 30 days of your receipt of this card:
The action you requested is normally processed within Z/IJ days.
D A copy of your action has been forwarded to our License Fee & Accounts Receivable Branch, who will contact you separately if there is a fee issue involved.
~ Your action has been assiqned Mail Control Number th 5 7 6 5 3 v When calling to inquire about this action, please refer to this mail control number. You may call me at (817) 860-8103.
NRC FORM 532 (RIV) (10-2010)
BETWEEN:
Accounts Receivable/Payable and
Regional Licensing Branches
[ FOR ARPB USE 1 INFORMATION FROM L TS
Program Code: 02120 Status Code: Pending Amendment Fee Category: 7C Exp. Date: Fee Comments: CODE 21 Decom Fin Assur Reqd: N
License Fee Worksheet - License Fee Transmittal
A. REGION
1. APPLICATION ATIACHED ApplicanULicensee: AVERA SACRED HEART HOSPITAL
Received Date: 12/13/2011 Docket Number: 3003235
Mail Control Number: 576535 License Number: 40-01683-01
Action Type: Amendment
2. FEE ATIACHED
Amount:
Check No.: /1/' ILl
3. COMMENTS
Signed:
Date:
B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered I I
1. Fee Category and Amount:
2. Correct Fee Paid. Application may be processed for:
Amendment:
Renewal:
License:
3. OTHER ______________ _
Signed:
Date: