South Dakota Department of Health Forms

This form is used for requesting vital records in the state of South Dakota, such as birth certificates, death certificates, and marriage certificates. It allows individuals to obtain official copies of these records for legal and personal purposes.

This form is used for inspection of ambulances used in the South Dakota EMS Program for ground services. It ensures compliance with safety and operational standards.

This document provides guidelines and procedures for inspecting, testing, and purging natural gas systems in South Dakota. It ensures safe and efficient operation of the systems.

This document is for the performance testing of medical gas system installers in South Dakota. It ensures that installers meet the necessary standards for installing and maintaining medical gas systems in the state.

This document provides guidance on the disinfection of potable water systems in South Dakota. It outlines the necessary steps to ensure that the water is safe for consumption.

This document is used for reporting fire incidents that occur at health care facilities in South Dakota.

This Form is used for reporting safety drills conducted in nursing homes in South Dakota.

This document is used for keeping a record of emergency lighting tests conducted in South Dakota.

This document is a log specifically for Speech-Language Pathology Assistant (SLPA) Supervisors in South Dakota. It is used to track and document the supervision provided to SLPA's within the state.

This document is an application for the use of Automated Mechanical Distribution Devices (AMDD) in South Dakota. It is used to request permission to use these devices for distribution purposes.

This form is used for notifying resident and nonresident pharmacies in South Dakota about changes in their information or operations.

This type of document is a record of medications provided by the Veterans Administration for unit dosing. It is specific to South Dakota.

This document provides an outline of the recommended immunization protocol followed in South Dakota to protect individuals from vaccine-preventable diseases. It includes information about the vaccines, schedules, and guidelines for various age groups.

This document is used for keeping a record of medications obtained from other pharmacies for unit dosing in South Dakota.

This type of document is a template for a collaborative agreement in South Dakota. It outlines the terms and conditions of a collaboration between two or more parties, including responsibilities, goals, and terms of termination.

This form is used to provide additional information or documentation for the application or renewal of a pharmacy license in South Dakota. The form must be notarized before submission.

This document is used for requesting a change of the Pharmacist in Charge (PIC) in South Dakota.

This form is used for tracking temperature and symptoms related to Covid-19 in South Dakota.

This form is used for requisitioning laboratory tests related to the SARS-CoV-2 virus in South Dakota. It also includes an evaluation form for Persons Under Investigation (PUI) for COVID-19.

This type of document provides information about the Sentinel Testing program for K-12 school staff in South Dakota.

This document is used for requesting sentinel surveillance for long-term care facilities in South Dakota.

This document is used to request laboratory services for first responders in South Dakota.

This form is used for requesting a staffing exception for assisted living centers with stand-alone facilities of 16 beds or less in South Dakota.

This document is a request form used to apply for a staffing exception for assisted living centers with 17-25 beds in South Dakota.

This document is for requesting a staffing exception for assisted living centers with 16 beds or less in South Dakota.

This document is a staffing exception request form for assisted living centers with 11 to 16 beds in South Dakota. It is used to request additional staff for these specific centers.

This document is an application for obtaining a license to operate an adult foster care home in South Dakota.

This Form is used for applying for a license to operate an Assisted Living Center in South Dakota.

This form is used for applying for a license to operate a chemical dependency treatment facility in South Dakota.

This document is a template for a residential agreement in a Community Living Home (CLH) in South Dakota. It outlines the terms and conditions for living in a CLH.

This document is for obtaining a license to operate an inpatient hospice facility in South Dakota.

This form is used for applying for a license to operate a hospital in the state of South Dakota.

This form is used for registering a residential living center in South Dakota.

This form is used for applying for a license to operate an ambulatory surgery center in South Dakota.

This document is used for applying for a license to operate a nursing facility in the state of South Dakota.

This document is for individuals or organizations looking to obtain a license to operate a community living home in South Dakota.

This form is used for applying for a license for a radiation machine (ionizing) in South Dakota.

This form is used for applying for a license to operate a residential hospice facility in the state of South Dakota.

This document is used for evaluating residents of a residential living center in South Dakota.