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Get Printable Ca 17 Form 2017-2024

Mber (if applicable): CDPH 8623 (10/17) Page 2 of 7 State of California – Health and Human Services Agency California Department of Public Health Radiologic Health Branch Section 6 – Personnel Qualifications a. Physician’s Qualifications. List all the physicians who interpret mammography exams for this facility. Use additional sheets if necessary. ABR, AOBR, or Supervisor/ RCPSC Certified in Check if California Supervisor/ Operator Diagnostic Lead Medical Board Operator Certificate/ .

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