X-ray Service Providers

Minnesota Statute, 144.121 requires individual Service Providers (not companies) of ionizing radiation-producing equipment and other sources of ionizing radiation must pay an initial or annual renewal fee of $115 to register with the Minnesota Department of Health. After MDH reviews and approves a completed registration form, Service Providers will have a certificate to carry with them to provide proof they are a registered Service Provider with the State of Minnesota. Service Providers must provide their certificate number on all signed work forms.

Guidance documents

• Service Provider Welcome Packet (PDF)
• Service Provider Tennessen Warning (PDF)

Registration forms

• Service Provider Registration form (PDF)
• Service Provider Renewal Registration form (PDF)
• Service Provider Change of Information form (PDF)
• Service Provider Physicist Assistant Application (PDF)
• Service Provider Physicist Assistant Supervisory Attestation (PDF)

Important Note: Please submit any additional required documentation to MDH, failure to do this will delay your application process.

1. The Service Provider application and fee process is the same for the initial application and the renewal application.
2. Complete the required registration form(s) above.
3. Applicants will mail the completed Service Provider registration form(s) and include a $115.00 money order or cashier’s check payable to MDH.
4. The mailing address for the Service Provider registration form(s) is:
   Minnesota Department of Health Radiation Control
   X-ray Unit
   PO Box 64497 
   St. Paul, MN 55164-0497
5. Personal or business checks are not acceptable and will be destroyed. Fees are nonrefundable and nontransferable.
6. MDH recommends typing or writing legibly on the registration form(s) and sending it Certified Mail.
7. Physicist assistants will need to complete and submit all required documentation.
8. MDH will review the registration form(s) and send an email to the applicant regarding application status.
9. MDH will mail certificate.

Notification requirement

A service provider selling, leasing, or transferring x-ray equipment is required to notify the commissioner in writing within 15 days of the sale, lease, or transfer. The FDA Form 2579 can be used to meet this requirement.

• X-ray Equipment Notification form (PDF)

Lists

• Physicist List (PDF)
• Registered Service Provider Companies (alpha sort) (PDF)
• Registered Service Provider Companies (state/city sort) (PDF)