Permissible Practices Documentation for Dental Assistants Form - dental ohio 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, where you will enter your personal information including your name, Radiographer Certificate number, and any other names used. Ensure accuracy as this information is crucial.
3. Proceed to Section 2 to provide details about your supervising dentist. Fill in their Ohio License number, practice name, and address. This section confirms the dentist's evaluation of your skills.
4. In Section 3, indicate your qualifications for monitoring nitrous oxide-oxygen minimal sedation. Attach necessary certifications and select the appropriate box based on your training status.
5. Continue through Sections 4 to 7, providing required documentation for each function you are qualified to perform, such as radiography and coronal polishing. Attach all supporting documents as specified.
6. Complete the attestation in Section 10 by signing and dating the form, confirming that all information provided is accurate and truthful.

Start editing your form today on our platform for free!