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Forms

Most applications are now available online through the KBMIRT Licensing Portal.

Radiography, Nuclear Medicine, Radiation Therapy, and Radiologist Assistant Applications*:

Initial License Application: Medical Imaging & Radiation Therapy & Initial Kentucky Radiation License App Instructions

NOW AVAILABLE ONLINE!! Go to the Application Portal to begin your initial license application.

Reinstatement Application: Medical Imaging and Radiation Therapy (License Lapsed More Than Twelve Months) & Reinstatement Instructions
Reinstatement Application: Medical Imaging and Radiation Therapy (License Lapsed Less Than Twelve Months) & Reinstatement Instructions
Temporary License Application: Medical Imaging & Radiation Therapy & Temporary License Application Instructions

NOW AVAILABLE ONLINE!! Go to the Application Portal to begin your temporary license application.

Renewal Application: Medical Imaging & Radiation Therapy

NOW AVAILABLE ONLINE!! Go to the Licensee Portal to begin your renewal application.

Provisional Training License Application

NOW AVAILABLE ONLINE!! Go to the Licensee Portal to begin your provisional training application.

Form: Temporary License to Permanent License
Form: Add Post-Primary Certification to License

NOW AVAILABLE ONLINE!! Go to the Licensee Portal to add your post-primary certification.

*See below for information regarding reinstatement of a lapsed license.

Limited X-ray Machine Operator (LXMO) Applications*:

License Application: Limited X-ray Machine Operators & LXMO Initial License Application Instructions

NOW AVAILABLE ONLINE!! Go to the Application Portal to begin your initial license application.

Temporary License Application: Limited X-ray Machine Operators & Temporary LXMO License Application Instructions

NOW AVAILABLE ONLINE!! Go to the Application Portal to begin your initial license application

Renewal Application: Limited X-ray Machine Operators

NOW AVAILABLE ONLINE!! Go to the Licensee Portal to begin your renewal application.

Reinstatement Application: Limited X-ray Machine Operator (License Lapsed More Than Twelve Months)
Reinstatement Application: Limited X-ray Machine Operator (License Lapsed Less Than Twelve Months)
Form: Temporary License to Permanent LXMO License
Kentucky Limited Scope Radiography Exam Qualification Form

NOW AVAILABLE ONLINE!! Go to the Application Portal to begin your limited scope exam application.

ATTN LXMO Applicants: If you are applying for a Limited X-ray Machine Operator license and have completed your training out-of-state please contact the KBMIRT office for further instructions on documentation that needs to accompany the application.

*See below for information regarding reinstatement of a lapsed license.

Other Forms:

Continuing Education Approval Form NOW AVAILABLE ONLINE!! Go to the CE Sponsor Portal to submit approval requests.
Name/Address Change Form NOW AVAILABLE ONLINE!! Go to the Licensee Portal to submit your name change request.
CE Documentation Form, KBMIRT Form 8
Open Records Request Form
Program Director Verification-Temporary LXMO License
Program Director Verification-Temporary Radiation License (Medical Imaging & Radiation Therapy)
Provisional Training License Application-Supervisor Form

Reinstatement Process:

Following the expiration of a license, an individual may apply for reinstatement using the guidelines listed below. Please note, in addition to the application fee, the $100 reinstatement fee applies in each of the guidelines. If an individual's name has changed since license expired, documentation of name change is required (i.e. marriage license, divorce decree, etc).

Radiography, Nuclear Medicine, Radiation Therapy, and Radiologist Assistant Reinstatement:

Less than twelve (12) months since expiration of license: see 201 KAR 46:040, Section 7(1)
More than twelve (12) months since expiration of license: see 201 KAR 46:040, Section 7 (2)

Limited X-ray Machine Operator Reinstatement:

Less than twelve (12) months since expiration of license: see 201 KAR 46:081, Section 11
More than twelve (12) months since expiration of license: see 201 KAR 46:081, Section 11

Forms

Most applications are now available online through the KBMIRT Licensing Portal​.​

Limited X-ray Machine Operator (LXMO) Applications*:

Other Forms:

Reinstatement Process:

Most applications are now available online through the KBMIRT Licensing Portal.