Fillable Radiologic Technology Pregnancy Policy (Indian Hills Community College)

Fill Online, Printable, Fillable, Blank Radiologic Technology Pregnancy Policy (Indian Hills Community College) Form

Use Fill to complete blank online INDIAN HILLS COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Radiologic Technology Pregnancy Policy (Indian Hills Community College)

On average this form takes 2 minutes to complete

The Radiologic Technology Pregnancy Policy (Indian Hills Community College) form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 2 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Indian Hills Community College

BROWSE INDIAN HILLS COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Pregnancy Policy
Radiologic Technology Program
According to the U.S. Nuclear Regulatory Commission: Regulatory Guide 8.13 – A student enrolled in the
Radiologic Technology Program who becomes pregnant will be provided the following options related to the
pregnancy.
The regulations allow a pregnant student to decide whether to formally declare the pregnancy to the advantage
of lower dose limits for the embryo/fetus. The choice whether to declare a pregnancy is completely voluntary.
The Radiologic Technology Program provides the following options:
1. A student may voluntarily declare the pregnancy by notifying the Program Director in writing and
providing a physician’s statement that includes name, a declaration of pregnancy, the estimated date of
conception (only month and year need to be provided), and the date that Program Director was provided
the letter. If this option is chosen the student will conference with the Program Director regarding NRC
Regulations and potential risk. Students that declare a pregnancy may continue in the program without any
modification to didactic and clinical education course requirements.
If the student chooses to voluntarily declare the pregnancy, the following options will be provided.
The student may:
a. Sign a Release of Liability Statement releasing Indian Hills Community College and the
Clinical Education Setting from liability and continue in the program. The signed “Release of
Responsibility” will be included in the student’s permanent IHCC records. The student will review
a copy of the radiation Protection Regulations and Current Reports from the National Council for
Radiation Protection and the Nuclear Regulatory Commission regarding the eects of radiation on
the unborn fetus. The student will be provided an additional fetal monitoring dosimeter and will be
directed in the use of this dosimeter.
b. Withdraw from the Radiologic Technology Program and re-enter when an opening is available.
Typically, this would be in the following year.
2. If the student chooses not to declare the pregnancy no further action by the Program Director or other
ocials will result.
Name:
Signature: Date:
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Radiologic Technology Pregnancy Policy (Indian Hills Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document