Applications/Documents

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 (308 kb PDF)
    Dentist- Application by Credential Verifcation Download (320 kb PDF)
    Dentist- Application to Administer Nitrous Oxide Download (40 kb PDF)
    Dentist- Application to Administer Moderate Sedation Download (164 kb PDF)
    Dentist- Application to Administer General Anesthesia and Deep Sedation Download (116 kb PDF)
    Temporary Volunteer Registration Application Download (83 kb PDF)
    Dentist- Host Permit Application Download (125 kb PDF)

Corporations

    Dental Corporation and LLC Application for Registration Download (59 kb PDF)
    Corporate Practice Change in Ownership or Management Download (41 kb PDF)

Dental Hygienists

    Dental Hygienist- Application for New License Download (229 kb PDF)
    Dental Hygienist- Application for Credential License Download (316 kb PDF)
    Dental Hygienist- Application to Administer Nitrous Oxide Download (107 kb PDF)
    Dental Hygienist- Application to Administer Local Anesthesia Download (111 kb PDF)
    Dental Hygienist- Application to Monitor General Anesthesia, Deep Sedation, or Moderate Sedation Download (322 kb PDF)
    Temporary Volunteer Registration Application Download (83 kb PDF)

Advanced Dental Assistants

    Registered Dental Assistant- Application for Registration Download (275 kb PDF)
    Registered Dental Assistant- Application to Administer Nitrous Oxide Download (108 kb PDF)
    Registered Dental Assistant- Application to Monitor General, Deep Sedation, or Moderate Sedation Download (322 kb PDF)
    RDA v DA infographic Download (126 kb PDF)

Radiographers

    Radiographer- Application for Registration Download (173 kb PDF)

Dental Assistants

    Dental Assistant- Application to Monitor General Anesthesia, Deep Sedation, or Moderate Sedation Download (322 kb PDF)

General

    Collaborative Supervision Agreement Download (108 kb PDF)
    Collaborative Supervision Application Download (86 kb PDF)
    Additional Satellite Office Form Download (32 kb PDF)
    Practitioner List Request Form Download (61 kb PDF)
    Replacement Certificate Request Form Download (78 kb PDF)
    Application for Continuing Education Course Honorarium Download (98 kb PDF)
    CE Approval Request Form Download (85 kb PDF)
    ARSD 20:43:08 Draft Download (283 kb PDF)
    Anesthesia Updates Draft Download (301 kb PDF)
    Scope of Practice Decision Making Framework Download (182 kb PDF)
    Anesthesia Credentials Committee Meeting Notes- May 4, 2020 Download (64 kb PDF)
    Anesthesia Credentials Committee Meeting Notes- August 11, 2020 Download (63 kb PDF)
    Anesthesia Credentials Committee Meeting Notes- September 1, 2020 Download (64 kb PDF)
    Anesthesia Credentials Committee Meeting Notes- September 21, 2020 Download (64 kb PDF)
    Anesthesia Credentials Committee Meeting Notes- October 5, 2020 Download (62 kb PDF)
    ARSD 20:43:09 2nd draft for public review Download (13807 kb PDF)
    ARSD 20.43.09 Final Draft posted 9.9.2021 Download (340 kb PDF)
    Summary of Rule Changes Download (167 kb PDF)
    Inspection Summary Download (134 kb PDF)
    Permit Summary Download (106 kb PDF)
    Host Permit Course Information Download (41 kb PDF)
    Notice of Public Hearing Download (14 kb PDF)
    Written Public Comments Download (9233 kb PDF)
    ARSD 20:43:09 Download (338 kb PDF)
    Draft Advertising and Specialty Advertising (ARSD 20:43:04:01) Administrative Rules Download (157 kb PDF)
    Draft Advertising/ Specialty Advertising and Exam Administrative Rules Download (198 kb PDF)
    Draft Advertising Rules with Feedback 9.29.2022 Download (198 kb PDF)
    Collaborative Supervision Silver Diamine Fluoride Addendum Download (69 kb PDF)
    Draft Administrative Rules_ Advertising_4.26.2023 Download (249 kb PDF)
    Public Notice_5.1.2023 Download (491 kb PDF)
    Revised Administrative Rules 7.18.2023 Download (249 kb PDF)
    Draft Administrative Rules Download (237 kb PDF)
    Public Notice Download (12 kb PDF)
    Draft Administrative Rules with Legislative Research Council Form and Style Changes Incorporated Download (303 kb PDF)
    Public Notice Download (13 kb PDF)
    Draft Administrative Rules Download (195 kb PDF)
    Council of State Governments Compact Presentation Download (1483 kb PDF)
    AADB Compact Presentation Download (4763 kb PDF)
    Administrative Rules- Written Comments Download (344 kb PDF)

Sedation/Anesthesia

    Moderate Sedation Permit - List of Approved Courses Download (125 kb PDF)
    Moderate Sedation Permit - Course Approval Request Form Download (141 kb PDF)
    Permit to Monitor General Anesthesia, Deep Sedation or Moderate Sedation - List of Approved Courses Download (92 kb PDF)
    Permit to Monitor General Anesthesia, Deep Sedation or Moderate Sedation - Course Approval Request Form Download (87 kb PDF)
    Practitioner Manual for Office Anesthesia Evaluation Download (195 kb PDF)
    Office Anesthesia Inspection Form Download (178 kb PDF)
    Temporary Permit- Facility Only Inspection Form Download (253 kb PDF)
    Anesthesia Inspector Travel Voucher Download (55 kb PDF)
    Adverse Condition Report Form Download (378 kb PDF)
    Host Permit Course Request Form Download (131 kb PDF)
    Inspection Proposed Changes Infographic Download (135 kb PDF)
    Form T1: Facility Inspection Practitioner Checklist Download (254 kb PDF)
    Form T2: Facility Inspection Results Form Download (241 kb PDF)
    Form 1: Full Inspection Practitioner Checklist Download (265 kb PDF)
    Form 2: Full Inspection Results Form (Checklist and Records Review) Download (223 kb PDF)
    Form 3: Full Inspection Results Form (Emergency Response) Download (325 kb PDF)
    Stakeholder Feedback for the Anesthesia Inspection Process Download (2131 kb PDF)
    ACC Application Download (54 kb PDF)
    ACC Open Terms Download (318 kb PDF)
    ACC Open Terms 2022 Download (363 kb PDF)
    Anesthesia Administrative Rules Presentation 5.12.2022 Download (1252 kb PDF)
    ACC Open Positions Download (14 kb PDF)
Page Updated: 3/8/2013 11:20:41 AM