1. Notification to Authorities: Notification to Authorities: RADIOACTIVE MATERIAL PROCEDURE RADIOACTIVE MATERIAL PROCEDURE [Insert Institution Name Only] __________________________ ________________________ Patient Name Patient ID # has undergone a medical procedure that involved the use of radioactive material on _____________________. The medical procedure was ___________________________. Even though the radioactivity is of little risk, it may activate radiation detection equipment until the time period listed on the back is reached. For any further information or confirmation please call a number listed on the back of this card. Notification to Authorities: Notification to Authorities: RADIOACTIVE MATERIAL PROCEDURE RADIOACTIVE MATERIAL PROCEDURE [Insert Institution Name Only] __________________________ ________________________ Patient Name Patient ID # has undergone a medical procedure that involved the use of radioactive material on _____________________. The medical procedure was ___________________________. Even though the radioactivity is of little risk, it may activate radiation detection equipment until the time period listed on the back is reached. For any further information or confirmation please call a number listed on the back of this card. Notification to Authorities: Notification to Authorities: RADIOACTIVE MATERIAL PROCEDURE RADIOACTIVE MATERIAL PROCEDURE [Insert Institution Name Only] __________________________ ________________________ Patient Name Patient ID # has undergone a medical procedure that involved the use of radioactive material on _____________________. The medical procedure was ___________________________. Even though the radioactivity is of little risk, it may activate radiation detection equipment until the time period listed on the back is reached. For any further information or confirmation please call a number listed on the back of this card. Notification to Authorities: Notification to Authorities: RADIOACTIVE MATERIAL PROCEDURE RADIOACTIVE MATERIAL PROCEDURE [Insert Institution Name Only] __________________________ ________________________ Patient Name Patient ID # has undergone a medical procedure that involved the use of radioactive material on _____________________. The medical procedure was ___________________________. Even though the radioactivity is of little risk, it may activate radiation detection equipment until the time period listed on the back is reached. For any further information or confirmation please call a number listed on the back of this card. Notification to Authorities: Notification to Authorities: RADIOACTIVE MATERIAL PROCEDURE RADIOACTIVE MATERIAL PROCEDURE [Insert Institution Name Only] __________________________ ________________________ Patient Name Patient ID # has undergone a medical procedure that involved the use of radioactive material on _____________________. The medical procedure was ___________________________. Even though the radioactivity is of little risk, it may activate radiation detection equipment until the time period listed on the back is reached. For any further information or confirmation please call a number listed on the back of this card. Notification to Authorities: Notification to Authorities: RADIOACTIVE MATERIAL PROCEDURE RADIOACTIVE MATERIAL PROCEDURE [Insert Institution Name Only] __________________________ ________________________ Patient Name Patient ID # has undergone a medical procedure that involved the use of radioactive material on _____________________. The medical procedure was ___________________________. Even though the radioactivity is of little risk, it may activate radiation detection equipment until the time period listed on the back is reached. For any further information or confirmation please call a number listed on the back of this card.

2. Radiation Safety Office: _____________________ Nuclear Medicine, Radiology or Radiation Oncology Dept. :______________________________________Other:___________________________________ RADIONUCLIDE INFORMATION* TC 99-M 2.5 days TL 201 30 days I-123 5.5 days I-131 80 days IN-111 28 days GA-67 33 days Other:_____________________________ *Over these times, the amount of radioactivity will decrease by one-half 10 times.. Radiation Safety Office: _____________________ Nuclear Medicine, Radiology or Radiation Oncology Dept. :______________________________________Other:___________________________________ RADIONUCLIDE INFORMATION* TC 99-M 2.5 days TL 201 30 days I-123 5.5 days I-131 80 days IN-111 28 days GA-67 33 days Other:_____________________________ *Over these times, the amount of radioactivity will decrease by one-half 10 times.. Radiation Safety Office: _____________________ Nuclear Medicine, Radiology or Radiation Oncology Dept. :______________________________________Other:___________________________________ RADIONUCLIDE INFORMATION* TC 99-M 2.5 days TL 201 30 days I-123 5.5 days I-131 80 days IN-111 28 days GA-67 33 days Other:_____________________________ *Over these times, the amount of radioactivity will decrease by one-half 10 times.. Radiation Safety Office: _____________________ Nuclear Medicine, Radiology or Radiation Oncology Dept. :______________________________________Other:___________________________________ RADIONUCLIDE INFORMATION* TC 99-M 2.5 days TL 201 30 days I-123 5.5 days I-131 80 days IN-111 28 days GA-67 33 days Other:_____________________________ *Over these times, the amount of radioactivity will decrease by one-half 10 times.. Radiation Safety Office: _____________________ Nuclear Medicine, Radiology or Radiation Oncology Dept. :______________________________________Other:___________________________________ RADIONUCLIDE INFORMATION* TC 99-M 2.5 days TL 201 30 days I-123 5.5 days I-131 80 days IN-111 28 days GA-67 33 days Other:_____________________________ *Over these times, the amount of radioactivity will decrease by one-half 10 times.. Radiation Safety Office: _____________________ Nuclear Medicine, Radiology or Radiation Oncology Dept. :______________________________________Other:___________________________________ RADIONUCLIDE INFORMATION* TC 99-M 2.5 days TL 201 30 days I-123 5.5 days I-131 80 days IN-111 28 days GA-67 33 days Other:_____________________________ *Over these times, the amount of radioactivity will decrease by one-half 10 times..