Potassium Iodide (KI) Application Form

Potassium Iodide (KI) Application Form

The Nuclear Regulatory Commission (NRC) has enabled each individual who lives or works in the Emergency Planning Zone (EPZ) surrounding the Seabrook Nuclear Station to receive one dose of Potassium Iodide (KI) from the State of New Hampshire to use in the event of a radiological emergency. Institutions and businesses in these areas may also request a supply of KI by contacting the New Hampshire Department of Public Health Services (DPHS) at rep@dhhs.nh.gov.

Name(Required)
Mailing Address(Required)
(2 – 65mg tabs each)
(1 – 65mg tab each)
By completing and submitting this application to receive potassium iodide tablets from the State of New Hampshire, I understand the following:(Required)
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