Dosimeter Change In-Service Form

1. User Information
You must complete all of the information in this section of the form.
2. Discontinue Dosimeter Service
(Example xx-xxx)
3. Reactivate
User information and MFK REQUIRED. Participant that has previously been in the EHS system.
4. Address Change for Current Participant
New information REQUIRED.
5. Add/Delete Dosimter Type(s) to active particpant
6. Name Change
7. New or Change in Master File Key (MFK) billing info
Additional Information
Updated 05/01/2013
Contact Barb Vitense at 335-9550 or