Sponsored yera •• Presentation Sisters Sacred Heart · yera •• Sacred Heart Hospital December 5,2011 U.S. NRC Region IV Texas Health Resources Tower Licensing Section 612

•• yera Sacred Heart Hospital

December 5,2011

U.S. NRC Region IV Texas Health Resources Tower Licensing Section 612 E. Lamar Blvd., Suite 400 Arlington, TX 76011-4125

Ref: License # 40-01683-01

Gentlemen:

Sponsored by the Benedictine and Presentation Sisters

501 Summit Yankton, SD 57078-3899 (605) 668-8000

RECEIVED

DEC 1 3 2011

IDNMS

Please amend our license to include Ralph Tullo MD who is currently authorized to perform 35.100 and 200 studies, also to perform procedures permitted under section 35.300. We are attaching his Florida license wherein he is identified to perform procedures requiring written directive,

Please feel free to contact our Radiation Safety Officer S. Guru Prasad, Ph.D. at 847-570-1535 or 847 921-3462 if you have any questions regarding this request.

Sincerely,

Barry Graham, MD VP Medical Affairs

/h576535

: STATE OF FLORIDA DEPARTMENT OF HEALlH

BUREAU OF RADIATION CONTROL

RAD~OACTIVE MATERIALS LICENSE . SUPPLEMENTAL SHEET

CENTRAL FL.ORIDA REGIONAL HOSPITAL, INC. d/b/a Central Florida Regional Hospital 1401 West Seminole'Boulevard : Sanford, FL 32771

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With reference to correspondence d81ted July 12~ 2011, State.of, Florida Radioactive Materials License Number 2490-1 is hereby.amended .. l,' ... ·, :,.:;i, . _',. .... \

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The fotlowing individuals or persons under th~ir· supervision. are. authorized for the materials and u·sesas irldic;a~ed::, ' .. ',<: . . .. . ... : ... ,. ... :

64E-S.630(2), (4) and 64E:.-5:63? .:::... ..' ::· .. :.Ste¥~·n:.~;.~:~~ter.· Nl.D. ' ... ' ..: ,': ,..:. .'. ;:".. .'.: ::.:.:'<:. ·'~~o,h..np~·~ ~.ooper, M p.

64E-5.632

64E-5.632(3) and (4)

64E-5.626(1), (2). 64E-5.627(1), ~(2) and 64E~5.630 (2). (3)

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64E-5.626(1), (2) and 64E-5,627(1). (2)

Sholmo Liebowich, M.D. Reuven Porges. M.D. Ajay Doddapaneni, M.D.

Jorge Gomez, M.D. Sharon Anderson, M.D.

License Number; 2490-1 Amendment No.: 61

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Control Number: 20110713-1181

LICENSEE COpy

Page 1 of 3 page( s) Expiration Date: 6/3012.014 a

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SUBPARTC UPTA;KE) DILUTION, AND EXCRETION

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64E-5.626 Use of RadimarmaceuticalS fQr Uptake, Dilution, or Excretion Studies. ((§ltHW!UIt.Ui3!j,r?F A licensee is allowed to use any p~~g~t{giiradioactive material in a radiopharmaceutical for a d use urements of uptake. dilution, or excretion for medical ~se !

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(a) Obtained from a manufacturer or pharmacy licensed as specified in; subsection 64lE-5.21 0(10), F.A.C., or in equivalent U.S. Nuclear I Regulatory Ccimmission,or Agreement State regulations; or I

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64E-S :Florida Administrative Code 64E-5.627 "

W~@i\m@ijg Authority: 404.022. 404.051.404.061,404.071, 404.081, 404.141. F.S. I

Law ImplemGnted; 404.022.404.051(1). (4). (:5). (6). (8). (9). (10). (11). 404,061(2,): ,3~'",::lH,~"~?t(.1),,,194,081, 404,141, F.S. History: New 8-25-91. Amendt;)d 5-12-93. Formerly 10D-91.735, Amended 8-6-01ij '" ',. \;i~\,,\!,~ . !

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SUBPART E . RADIO~HARMACEUTJCALS FOR THERAPY

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BM.l~m~~i1i!9' Authority~ 404.022, 404.051, 404.061, 404.071, 404.081, 404.141, F.S. U,lW Implomented: 404.022, 404.051(1), (4);: (5), (6), (8), (9), (i0). (11), 404.061(2 '. ~3~, 404,P?,1P)!,.494.081 , 404.141, F.S. History: New 8-25-91, Amended 5-12-93, Formorly 100-91.739, Amended 8-6-01~ iN; . .¥i~ '~!.I..".

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SEAf:.ED SOURCES FOR DIAGNOSIS

Iodine 125 as a sealed source in a device for bone mineral analysis;

Iodine 125 as a sea~ed source in a portable device for imaging; I

Gadolinium 153 as i'jl sealed source in a device for bone mineral analysis; :,

Americiul)l 241 as a:sealed source in a device for bone mineral anaIYSis~;t~] . I

R1 0 f&.l€t(ri~~if.1g Authority: 404.022, 404.051, , 404.071, 404.081, 404.141, F,S. : L~w Impiem<lnted: 404.022, 404.051 (1), (4),.(9).. \~}. (8~"?0), (11), 404.061 (2), (3), 404.071(1), 404.081,404.141:. F.S.

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AveraFi Sacred Heart Hospital

501 Summit Street Yankton, SD 57078-3855

RECE\\lEO DEC 1 3 IQn

ONMS

Avera~ Sacred Heart Hospital

501 Summit Yankton, SD 57078-3899

TO:

U.S. NRC Region IV Texas Health Resources Tower Licensing Section 612 E. Lamar Blvd., Suite 400 Arlington, TX 76011-4125

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(DEC - 8 20ll

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.000"1292736 DEC0720'11 '.': MAILED FROM ZiP CODE 57078

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DEC 13 2011 This is to acknowledge the receipt of your letter/application dated· DATE

DEC - 5 2011 , and to inform you that the initial processing, which includes an administrative review, has been performed.

·~'~here were no administrative omissions. Your application will be assigned to a technical V ~~viewer. Please note that the technical review may identify other omissions or require additional information.

D Please provide to this office within 30 days of your receipt of this card:

The action you requested is normally processed within Z/IJ days.

D A copy of your action has been forwarded to our License Fee & Accounts Receivable Branch, who will contact you separately if there is a fee issue involved.

~ Your action has been assiqned Mail Control Number th 5 7 6 5 3 v When calling to inquire about this action, please refer to this mail control number. You may call me at (817) 860-8103.

NRC FORM 532 (RIV) (10-2010)

BETWEEN:

Accounts Receivable/Payable and

Regional Licensing Branches

[ FOR ARPB USE 1 INFORMATION FROM L TS

Program Code: 02120 Status Code: Pending Amendment Fee Category: 7C Exp. Date: Fee Comments: CODE 21 Decom Fin Assur Reqd: N

License Fee Worksheet - License Fee Transmittal

A. REGION

1. APPLICATION ATIACHED ApplicanULicensee: AVERA SACRED HEART HOSPITAL

Received Date: 12/13/2011 Docket Number: 3003235

Mail Control Number: 576535 License Number: 40-01683-01

Action Type: Amendment

2. FEE ATIACHED

Amount:

Check No.: /1/' ILl

3. COMMENTS

Signed:

Date:

B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered I I

1. Fee Category and Amount:

2. Correct Fee Paid. Application may be processed for:

Amendment:

Renewal:

License:

3. OTHER ______________ _

Signed:

Date: