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Permissible Practices Documentation for Dental Hygienists Form - dental ohio 2026

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

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