DDFORMS.ORG – DD Form 2164 – X-Ray Verification/Certification Worksheet – The DD Form 2164 X-Ray Verification Certification Worksheet is an important document for ensuring the accuracy and validity of radiologic examinations. This form is used to verify the technical quality of x-ray images and to certify that a radiologic technologist has completed all required steps in accordance with applicable regulations. It also serves as a record of the radiation dose administered and any corrective measures are taken when necessary.
Download DD Form 2164 – X-Ray Verification/Certification Worksheet
|DD Form 2164
|X-Ray Verification/Certification Worksheet
What is a DD Form 2164?
A DD Form 2164, also known as an X-Ray Verification Certification Worksheet, is a form that is used by the Department of Defense (DoD) to certify the results of a medical x-ray examination. This form certifies that all applicable DoD standards for radiation protection have been met and that all necessary technical qualifications have been satisfied. It is signed by the radiologist or attending physician who performed or supervised the x-ray examination and serves as documentation of said examination. The form must be completed and submitted to accompany any reportable diagnostic exams before they can be reported to any organization within DoD or outside it. Additionally, this form can also be used for other types of radiation examinations such as computed tomography scans and ultrasound imaging exams.
Where Can I Find a DD Form 2164?
The DD Form 2164, also known as the X-Ray Verification Certification Worksheet, is a form used to document that an individual has received and retained all necessary x-ray instruction and safety training. It is typically used by radiographers and other personnel who work in laboratories or clinics that perform x-rays. The form must be completed for each employee who works with x-rays, and it must be signed by both the individual receiving the training and a supervisor or manager.
The form can be found on the U.S. Department of Defense website under “Forms Library”. Additionally, printed copies of the DD Form 2164 can be obtained from a local military installation’s Personnel Support Detachment office or from any state military department where one works with x-rays. In order to receive a copy of this form, individuals should contact their local personnel support detachment office or state military department so they can provide them with the most up-to-date version of the form available.
DD Form 2164 – X-Ray Verification/Certification Worksheet
DD Form 2164 – X-Ray Verification Certification Worksheet is a form used to certify that x-rays were properly taken and checked for accuracy. It includes the certification of radiation safety measures and other pertinent details related to the performance of the x-ray procedure. The worksheet also serves as a record in case there is any dispute regarding the quality or accuracy of the x-ray results. This form should be filled out by medical personnel and must be completed before any x-ray procedure can be performed.
The DD Form 2164 – X-Ray Verification Certification Worksheet has sections where information such as patient name, age, sex, and anatomy being examined must be provided. It also requires information about the type of radiation protection used during the procedure, specific details about test equipment used, doses received by patients during the examination, and comments from staff or supervisors who have verified that all necessary standards have been met when performing the diagnostic imaging study. All this information must be accurately documented on this form in order for it to serve its intended purpose as a verification tool for ensuring quality control over medical treatments involving radiation exposure.
Finally, once completed this form should be kept with patient records as part of their medical history so that it can easily be retrieved if needed at a later date.