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DHS 157.71(4)(b)3. 3. The social security number or other identification number, if one has been assigned, of any person who is the subject of a medical event.
DHS 157.71(4)(b)4. 4. A brief description of the event and why it occurred.
DHS 157.71(4)(b)5. 5. The effect, if any, on any individual.
DHS 157.71(4)(b)6. 6. The actions, if any, taken or planned to prevent recurrence.
DHS 157.71(4)(b)7. 7. Whether the licensee notified the affected individual or the affected individual's responsible relative or guardian and, if not, whether the failure to notify was based on guidance from the referring physician.
DHS 157.71(5) (5)Record of a dose to an embryo or fetus or a nursing child. A licensee shall retain a record of a dose to an embryo or fetus or a nursing child reported under s. DHS 157.72 (2) for 3 years. The record shall contain all of the following:
DHS 157.71(5)(a) (a) The licensee's name.
DHS 157.71(5)(b) (b) The names of all the individuals involved.
DHS 157.71(5)(c) (c) The social security number or other identification number, if one has been assigned of the pregnant individual or nursing child who is the subject of the event.
DHS 157.71(5)(d) (d) A brief description of the event, why it occurred, any effect on the embryo or fetus or nursing child and any actions taken or planned to prevent recurrence.
DHS 157.71(5)(e) (e) Whether the licensee notified the pregnant individual or mother, or the mother's or child's responsible relative or guardian, and if the licensee did not, whether such failure to notify was based on guidance from the referring physician.
DHS 157.71(6) (6)Records of instrument calibrations. A licensee shall maintain a record of instrument calibrations required by s. DHS 157.62 (1) for 3 years. The record shall include the model and serial number of the instrument, the date of the calibration, the results of the calibration and the name of the individual who performed the calibration.
DHS 157.71(7) (7)Records of radiation survey instrument calibrations. A licensee shall maintain a record of radiation survey instrument calibrations required by s. DHS 157.62 (2) for 3 years. The record shall include the date of the calibration, the results of the calibration, the name of the person who performed the calibration, and the model and serial number of the instrument.
DHS 157.71(8) (8)Records of dosages of unsealed radioactive material for medical use. A licensee shall maintain a record of dosage determinations required by s. DHS 157.62 (3) for 3 years. The record shall contain the radiopharmaceutical, patient's or human research subject's name or identification number if one has been assigned, the prescribed dosage, the determined dosage or a notation that the total activity is less than 1.1 MBq (30 microcuries), the date and time of the dosage determination and the name of the individual who determined the dosage.
DHS 157.71(9) (9)Records of possession of sealed sources and brachytherapy sources.
DHS 157.71(9)(a) (a) A licensee shall retain a record of leak tests required by s. DHS 157.62 (5) (b) for 3 years. The record shall contain the model number and serial number if one has been assigned of each source tested, the identity of each source radionuclide and its estimated activity, the results of the test, the date of the test and the name of the person who performed the test.
DHS 157.71(9)(b) (b) A licensee shall retain a record of the semi-annual physical inventory of sealed sources and brachytherapy sources required by s. DHS 157.62 (5) (g) for 3 years. The inventory record shall contain the model number of each source and serial number if one has been assigned, the identity of each source radionuclide and its nominal activity, the location of each source and the name of the person who performed the inventory.
DHS 157.71(10) (10)Records of surveys for ambient radiation exposure rate. A licensee shall retain a record of each survey required by s. DHS 157.62 (7) for 3 years. The record shall include the date of the survey, the results of the survey, the instrument used to make the survey and the name of the person who performed the survey.
DHS 157.71(11) (11)Records of the release of persons containing radioactive drugs or implants containing radioactive material.
DHS 157.71(11)(a)(a) A licensee shall retain a record of the basis for authorizing the release of a person for 3 years after the date of release if the total effective dose equivalent is calculated by any of the following methods:
DHS 157.71(11)(a)1. 1. Using the retained radioactivity in the body rather than the radioactivity administered.
DHS 157.71(11)(a)2. 2. Using an occupancy factor less than 0.25 at one meter to determine radiation exposure to persons physically near the patient.
DHS 157.71(11)(a)3. 3. Using the biological or effective half-life of the radioactive material retained in the body.
DHS 157.71(11)(a)4. 4. Considering the shielding by tissue to calculate the exposure to persons physically near the patient.
DHS 157.71(11)(b) (b) A licensee shall retain a record for 3 years after the date of release that the instructions required by s. DHS 157.62 (8) (b) were provided to a breast-feeding woman if the radiation dose to the infant or child from continued breast-feeding could result in a total effective dose equivalent exceeding 5 mSv (0.5 rem).
DHS 157.71(12) (12)Records of administrative and technical requirements that apply to the provision of mobile services.
DHS 157.71(12)(a)(a) A licensee shall retain a copy of the letter that permits the use of radioactive material at a client's address of use, as required by s. DHS 157.62 (9) (a) 1., for 3 years after the last provision of service.
DHS 157.71(12)(b) (b) A licensee shall retain the record of each survey required by s. DHS 157.62 (9) (a) 4. for 3 years. The record shall include the date of the survey, the results of the survey, the instrument used to make the survey and the name of the person who performed the survey.
DHS 157.71(13) (13)Records of decay-in-storage. A licensee shall maintain a record of the disposal of licensed materials as required by s. DHS 157.62 (10) for 3 years. The record shall include the date of the disposal, the survey instrument used, the background dose rate, the dose rate measured at the surface of each waste container and the name of the person who performed the disposal.
DHS 157.71(14) (14)Records of contaminant concentration. A licensee shall maintain a record of the contaminant concentration tests required by s. DHS 157.63 (3) (b) for 3 years. The record shall include, for each measured elution or extract, all of the following:
DHS 157.71(14)(a) (a) The ratio of the measures expressed as kilobecquerel (microcurie) of molybdenum-99, strontium -82 or strontium-85 per megabecquerel of technetium-99m or rubidium-82 chloride injection.
DHS 157.71(14)(b) (b) The time and date of the measurement.
DHS 157.71(14)(c) (c) The name of the person who made the measurement.
DHS 157.71(15) (15)Records of instruction and training. A licensee shall maintain a record of instructions and training required by ss. DHS 157.64 (2), 157.65 (4) and 157.67 (4) for 3 years. The record shall include a list of the topics covered, the date of the instruction or training, the names of the attendees and the names of the persons who provided the instruction.
DHS 157.71(16) (16)Records of radiation surveys of patients and human research subjects. A licensee shall maintain a record of the surveys required by ss. DHS 157.65 (2) and 157.67 (2) for 3 years. Each record shall include the date and results of the survey, the survey instrument used and the name of the person who made the survey.
DHS 157.71(17) (17)Records of brachytherapy source inventory.
DHS 157.71(17)(a)(a) A licensee shall maintain a record of brachytherapy source accountability required by s. DHS 157.65 (3) for 3 years.
DHS 157.71(17)(b) (b) For temporary implants, the record shall include all of the following:
DHS 157.71(17)(b)1. 1. The number and activity of sources removed from storage, the time and date they were removed from storage, the name of the person who removed them from storage and the location of use.
DHS 157.71(17)(b)2. 2. The number and activity of sources returned to storage, the time and date they were returned to storage and the name of the person who returned them from storage.
DHS 157.71(17)(c) (c) For permanent implants, the record shall include all of the following:
DHS 157.71(17)(c)1. 1. The number and activity of sources removed from storage, the date they were removed from storage and the name of the person who removed them from storage.
DHS 157.71(17)(c)2. 2. The number and activity of sources returned to storage, the date they were returned to storage and the name of the person who returned them to storage.
DHS 157.71(17)(c)3. 3. The number and activity of sources permanently implanted in the patient or human research subject.
DHS 157.71(18) (18)Records of calibrations on brachytherapy sources. A licensee shall maintain a record of the calibrations on brachytherapy sources required by s. DHS 157.65 (6) for 3 years after the last use of the source. The record shall include the date of the calibration, the manufacturer's name, model number and serial number for the source and instruments used to calibrate the source, the source output or activity, source positioning accuracy within applicators and the signature of the authorized medical physicist.
DHS 157.71(19) (19)Records of installation, maintenance, adjustment and repair. A licensee shall retain a record of the installation, maintenance, adjustment and repair of remote afterloader units, teletherapy units and gamma stereotactic units as required by s. DHS 157.67 (3) for 3 years. For each installation, maintenance, adjustment and repair, the record shall include the date, description of the service and names of the persons who performed the work.
DHS 157.71(20) (20)Records of dosimetry equipment.
DHS 157.71(20)(a)(a) A licensee shall retain a record of the calibration, intercomparison and comparisons of its dosimetry equipment done under s. DHS 157.67 (6) for the duration of the license.
DHS 157.71(20)(b) (b) For each calibration, intercomparison or comparison, the record shall include all of the following:
DHS 157.71(20)(b)1. 1. The date.
DHS 157.71(20)(b)2. 2. The model numbers and serial numbers of the instruments that were calibrated, intercompared or compared.
DHS 157.71(20)(b)3. 3. The correction factor that was determined from the calibration or comparison or the apparent correction factor that was determined from an intercomparison.
DHS 157.71(20)(b)4. 4. The names of the persons who performed the calibration, intercomparison or comparison.
DHS 157.71(21) (21)Records of teletherapy, remote afterloader and gamma stereotactic radiosurgery full calibrations.
DHS 157.71(21)(a)(a) A licensee shall maintain a record of the teletherapy, remote afterloader and gamma stereotactic radiosurgery full calibrations required by s. DHS 157.67 (7) to (9) for 3 years.
DHS 157.71(21)(b) (b) The record required under par. (a) shall include all of the following:
DHS 157.71(21)(b)1. 1. The date of the calibration.
DHS 157.71(21)(b)2. 2. The manufacturer's name, model number and serial number for the teletherapy, remote afterloader and gamma stereotactic radiosurgery unit, source and instruments used to calibrate the unit.
DHS 157.71(21)(b)3. 3. The results and an assessment of the full calibrations.
DHS 157.71(21)(b)4. 4. The results of the autoradiograph required for low dose-rate remote afterloader units.
DHS 157.71(21)(b)5. 5. The signature of the authorized medical physicist who performed the full calibration.
DHS 157.71(22) (22)Records of periodic spot-checks for teletherapy units.
DHS 157.71(22)(a)(a) A licensee shall retain a record of each periodic spot-check for teletherapy units required by s. DHS 157.67 (10) for 3 years.
DHS 157.71(22)(b) (b) The record required under par. (a) shall include all of the following:
DHS 157.71(22)(b)1. 1. The date of the spot-check.
DHS 157.71(22)(b)2. 2. The manufacturer's name, model number and serial number for the teletherapy unit, source and instrument used to measure the output of the teletherapy unit.
DHS 157.71(22)(b)3. 3. An assessment of timer linearity and constancy.
DHS 157.71(22)(b)4. 4. The calculated on-off error.
DHS 157.71(22)(b)5. 5. A determination of the coincidence of the radiation field and the field indicated by the light beam localizing device.
DHS 157.71(22)(b)6. 6. The determined accuracy of each distance measuring and localization device.
DHS 157.71(22)(b)7. 7. The difference between the anticipated output and the measured output.
DHS 157.71(22)(b)8. 8. Notations indicating the operability of each entrance door electrical interlock, each electrical or mechanical stop, each source exposure indicator light and the viewing and intercom system and doors.
DHS 157.71(22)(b)9. 9. The name of the person who performed the periodic spot-check and the signature of the authorized medical physicist who reviewed the record of the spot-check.
DHS 157.71(23) (23)Records of periodic spot-checks for remote afterloader units.
DHS 157.71(23)(a)(a) A licensee shall retain a record of each spot-check for remote afterloader units required by s. DHS 157.67 (11) for 3 years.
DHS 157.71(23)(b) (b) The record required under par. (a) shall include all of the following, as applicable:
DHS 157.71(23)(b)1. 1. The date of the spot-check.
DHS 157.71(23)(b)2. 2. The manufacturer's name, model number and serial number for the remote afterloader unit and source.
DHS 157.71(23)(b)3. 3. An assessment of timer accuracy.
DHS 157.71(23)(b)4. 4. Notations indicating the operability of each entrance door electrical interlock, radiation monitors, source exposure indicator lights, viewing and intercom systems and clock and decayed source activity in the unit's computer.
DHS 157.71(23)(b)5. 5. The name of the person who performed the periodic spot-check and the signature of the authorized medical physicist who reviewed the record of the spot-check.
DHS 157.71(24) (24)Records of periodic spot-checks for gamma stereotactic radiosurgery units.
DHS 157.71(24)(a) (a) A licensee shall retain a record of each spot-check for gamma stereotactic radiosurgery units required by s. DHS 157.67 (12) for 3 years.
DHS 157.71(24)(b) (b) The record required under par. (a) shall include all of the following:
DHS 157.71(24)(b)1. 1. The date of the spot-check.
DHS 157.71(24)(b)2. 2. The manufacturer's name, model number and serial number for the gamma stereotactic radiosurgery unit and the instrument used to measure the output of the unit.
DHS 157.71(24)(b)3. 3. An assessment of timer linearity and accuracy.
DHS 157.71(24)(b)4. 4. The calculated on-off error.
DHS 157.71(24)(b)5. 5. A determination of trunnion centricity.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.