Get Rcp-supervision-form-editable.doc - Sdbmoe

Filling out the RCP-SUPERVISION-FORM-EDITABLE.doc is a crucial step for respiratory care practitioners seeking supervision from a licensed physician in South Dakota. This guide will walk you through each section of the form to ensure your submission is accurate and complete.

Follow the steps to successfully complete the supervision form online.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. Provide your printed name in the designated area under 'Respiratory Care Practitioner Information'.
3. Enter the name of your practice facility in the corresponding field labeled 'Practice Facility Name'.
4. Input your license number where indicated. If you do not have this information, you may leave it blank.
5. Fill in the date you are completing the form in the provided space.
6. Supply your practice address and contact details, including your phone number and email address.
7. List the proposed supervising providers. Enter their names and license numbers in the fields provided. If you are unsure of a license number, it can remain blank.
8. Specify the proposed start date and, if applicable, the end date of supervision.
9. Sign the form in the area designated for the signature of the respiratory care practitioner, certifying that the information provided is true and accurate.
10. Finally, indicate the date of your signature. Once all the information is complete, save your changes and choose to download, print, or share the form as needed.

Complete your documentation online to ensure a smooth supervision application process.