Document each performance. Elective Procedures Applicants must complete at least 3 different elective activities the number of times specified on page 3 of these clinical experience requirements. Document each performance below. List each procedure below. If performed multiple times, then list the procedure multiple times.
Abbreviations are acceptable.
Applicant Signature Applicants must fill in the dates below and sign when clinical experience requirements are completed. All requirements must be completed during the 12 months immediately preceding application for examination. By signing this Clinical Experience Documentation Form , the applicant attests to the accuracy of the information on Sections 1 through 4 on this form. Applicants should keep this form and related documentation in a file for 24 months. Do not mail this Clinical Experience Documentation Form to the ARRT with the application for examination.