Applications/Documents
Many South Dakota State Board of Dentistry forms are available in ADOBE .PDF format (Portable Document Format) which is both device and resolution independent. The printed version of these PDF documents will be similar regardless of the device used to print. In order to view, print or download these forms, you must have the free ADOBE Acrobat Reader for Windows, DOS or for Macintosh.
Dentists
| Dentist- Application for New License |
Download (637 kb PDF) |
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| Dentist- Application by Credential Verifcation |
Download (322 kb PDF) |
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| Dentist- Application to Administer Nitrous Oxide |
Download (40 kb PDF) |
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| Dentist- Application to Administer Moderate Sedation |
Download (181 kb PDF) |
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| Dentist- Application to Administer General Anesthesia and Deep Sedation |
Download (116 kb PDF) |
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| Temporary Volunteer Registration Application |
Download (83 kb PDF) |
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| Dentist- Host Permit Application |
Download (125 kb PDF) |
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Corporations
| Dental Corporation and LLC Application for Registration |
Download (59 kb PDF) |
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| Corporate Practice Change in Ownership or Management |
Download (40 kb PDF) |
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Dental Hygienists
| Dental Hygienist- Application for New License |
Download (349 kb PDF) |
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| Dental Hygienist- Application for Credential License |
Download (658 kb PDF) |
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| Dental Hygienist- Application to Administer Nitrous Oxide |
Download (107 kb PDF) |
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| Dental Hygienist- Application to Administer Local Anesthesia |
Download (111 kb PDF) |
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| Dental Hygienist- Application to Monitor General Anesthesia, Deep Sedation, or Moderate Sedation |
Download (322 kb PDF) |
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| Temporary Volunteer Registration Application |
Download (83 kb PDF) |
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Advanced Dental Assistants
| Registered Dental Assistant- Application for Registration |
Download (298 kb PDF) |
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| Registered Dental Assistant- Application to Administer Nitrous Oxide |
Download (108 kb PDF) |
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| Registered Dental Assistant- Application to Monitor General, Deep Sedation, or Moderate Sedation |
Download (322 kb PDF) |
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| RDA v DA infographic |
Download (126 kb PDF) |
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Radiographers
| Radiographer- Application for Registration |
Download (173 kb PDF) |
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Dental Assistants
| Dental Assistant- Application to Monitor General Anesthesia, Deep Sedation, or Moderate Sedation |
Download (322 kb PDF) |
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General
| Collaborative Supervision Agreement |
Download (145 kb PDF) |
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| Additional Satellite Office Form |
Download (32 kb PDF) |
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| Practitioner List Request Form |
Download (61 kb PDF) |
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| Replacement Certificate Request Form |
Download (78 kb PDF) |
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| Application for Continuing Education Course Honorarium |
Download (98 kb PDF) |
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| CE Approval Request Form |
Download (85 kb PDF) |
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| ARSD 20:43:08 Draft |
Download (283 kb PDF) |
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| Anesthesia Updates Draft |
Download (301 kb PDF) |
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| Scope of Practice Decision Making Framework |
Download (182 kb PDF) |
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| Anesthesia Credentials Committee Meeting Notes- May 4, 2020 |
Download (64 kb PDF) |
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| Anesthesia Credentials Committee Meeting Notes- August 11, 2020 |
Download (63 kb PDF) |
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| Anesthesia Credentials Committee Meeting Notes- September 1, 2020 |
Download (64 kb PDF) |
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| Anesthesia Credentials Committee Meeting Notes- September 21, 2020 |
Download (64 kb PDF) |
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| Anesthesia Credentials Committee Meeting Notes- October 5, 2020 |
Download (62 kb PDF) |
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| ARSD 20:43:09 2nd draft for public review |
Download (13807 kb PDF) |
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| ARSD 20.43.09 Final Draft posted 9.9.2021 |
Download (340 kb PDF) |
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| Summary of Rule Changes |
Download (167 kb PDF) |
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| Inspection Summary |
Download (134 kb PDF) |
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| Host Permit Course Information |
Download (41 kb PDF) |
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| Notice of Public Hearing |
Download (14 kb PDF) |
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| Written Public Comments |
Download (9233 kb PDF) |
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| Draft Advertising and Specialty Advertising (ARSD 20:43:04:01) Administrative Rules |
Download (157 kb PDF) |
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| Draft Advertising/ Specialty Advertising and Exam Administrative Rules |
Download (198 kb PDF) |
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| Draft Advertising Rules with Feedback 9.29.2022 |
Download (198 kb PDF) |
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| Draft Administrative Rules_ Advertising_4.26.2023 |
Download (249 kb PDF) |
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| Public Notice_5.1.2023 |
Download (491 kb PDF) |
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| Revised Administrative Rules 7.18.2023 |
Download (249 kb PDF) |
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| Draft Administrative Rules |
Download (237 kb PDF) |
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| Draft Administrative Rules with Legislative Research Council Form and Style Changes Incorporated |
Download (303 kb PDF) |
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| Draft Administrative Rules |
Download (195 kb PDF) |
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| Council of State Governments Compact Presentation |
Download (1483 kb PDF) |
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| AADB Compact Presentation |
Download (4763 kb PDF) |
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| Administrative Rules- Written Comments |
Download (344 kb PDF) |
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| SDDA Proposed Rules- Restorative Functions |
Download (383 kb PDF) |
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| SDDA Documentation- Restorative Functions |
Download (2879 kb PDF) |
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| SDDA Proposed Rules- Supragingival Scaling |
Download (387 kb PDF) |
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| SDDA Documentation- Supragingival Scaling |
Download (2497 kb PDF) |
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| SDDA Proposed Rules- Nitrous Oxide administration |
Download (381 kb PDF) |
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| SDDA Documentation- Nitrous Oxide administration |
Download (467 kb PDF) |
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| SDDA Administrative Rules Petition |
Download (446 kb PDF) |
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Sedation/Anesthesia
| Moderate Sedation Permit - List of Approved Courses |
Download (125 kb PDF) |
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| Moderate Sedation Permit - Course Approval Request Form |
Download (141 kb PDF) |
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| Permit to Monitor General Anesthesia, Deep Sedation or Moderate Sedation - List of Approved Courses |
Download (92 kb PDF) |
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| Permit to Monitor General Anesthesia, Deep Sedation or Moderate Sedation - Course Approval Request Form |
Download (87 kb PDF) |
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| Practitioner Manual for Office Anesthesia Evaluation |
Download (195 kb PDF) |
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| Office Anesthesia Inspection Form |
Download (178 kb PDF) |
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| Temporary Permit- Facility Only Inspection Form |
Download (253 kb PDF) |
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| Anesthesia Inspector Travel Voucher |
Download (55 kb PDF) |
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| Adverse Condition Report Form |
Download (378 kb PDF) |
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| Host Permit Course Request Form |
Download (131 kb PDF) |
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| Inspection Proposed Changes Infographic |
Download (135 kb PDF) |
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| Form T1: Facility Inspection Practitioner Checklist |
Download (254 kb PDF) |
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| Form T2: Facility Inspection Results Form |
Download (241 kb PDF) |
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| Form 1: Full Inspection Practitioner Checklist |
Download (265 kb PDF) |
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| Form 2: Full Inspection Results Form (Checklist and Records Review) |
Download (223 kb PDF) |
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| Form 3: Full Inspection Results Form (Emergency Response) |
Download (325 kb PDF) |
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| Stakeholder Feedback for the Anesthesia Inspection Process |
Download (2131 kb PDF) |
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| ACC Open Terms 2022 |
Download (363 kb PDF) |
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| Anesthesia Administrative Rules Presentation 5.12.2022 |
Download (1252 kb PDF) |
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