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Permissible Practices Documentation for Dental Hygienists Form - dental ohio 2026

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The document outlines the permissible practices and documentation requirements for dental hygienists in Ohio, detailing the necessary training, certifications, and procedures they must follow to administer local anesthesia, nitrous oxide-oxygen sedation, and practice in the absence of a supervising dentist. It emphasizes the importance of maintaining current CPR certification and provides guidelines for documenting qualifications and experiences in a dental office setting.

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Click ‘Get Form’ to open it in the editor.
Begin with Section 1, where you will enter your License/Certificate Holder Information. Fill in your name, Ohio License number, and any other names used.
Proceed to Section 2 to provide the Supervising Dentist Information. Include their name, license number, practice name, and address.
In Sections 3 through 6, indicate your qualifications for administering local anesthesia and nitrous oxide-oxygen sedation. Attach required documentation as specified.
Complete Section 7 by certifying your CPR certification status. Ensure you attach proof of completion from an approved organization.
Finally, review Section 9 for the Attestation statement. Sign and date to confirm that all information is accurate and complete.

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