Ariz. Admin. Code § tit. 9, ch. 7, art. 6, app A
A. Name and address of the applicant and, if applicable, the name and address of any person within this state that is authorized to act on behalf of the applicant;
B. Disease or conditions to be diagnosed using the proposed x-ray examination;
C. A detailed description of each x-ray examination that will be used in the diagnosis;
D. A description of the population to be examined in the screening program, using characteristics such as age, sex, physical condition, and other descriptive information;
E. An evaluation of any known alternative diagnostic modalities not involving ionizing radiation that could achieve the same diagnosis as a screening program and why these modalities have not been chosen;
F. An evaluation by a qualified expert of the x-ray equipment used in the screening program, which demonstrates that the x-ray equipment satisfies the requirements of this Article;
G. A description of the quality control program;
H. A copy of the technique chart for the planned x-ray examination;
I. The qualifications of each individual who will be operating the x-ray equipment;
J. The qualifications of the individual who will be supervising each operator of the x-ray equipment;
K. The name and address of the individual who will interpret each radiographic image;
L. A description of the planned procedures for advising a screened individual and the screened individual's physician of the screening procedure results, and the need for further medical care, and
M. A description of the procedures for retention or disposition of the radiographic images and other records pertaining to the x-ray examination.
Ariz. Admin. Code tit. 9, ch. 7, art. 6, app A