Follow the steps to complete your waiver/exemption request.

1. Press the ‘Get Form’ button to access the waiver/exemption form and open it in your document editor.
2. Fill in the 'Name of Dispenser' field with the full name of the entity requesting the waiver or exemption. Ensure that you do not use initials.
3. Enter the 'South Dakota License or Permit Number' in the designated field. This number identifies your registration with the state.
4. Complete the 'Street Address', 'City', 'State', and 'Zip Code' fields with the dispenser's physical address.
5. Provide the 'Name of Pharmacist-in-Charge' who oversees operations. This should be the full name of the responsible pharmacist.
6. Input the 'License Number of Pharmacist-in-Charge (Home State)', which identifies their licensure in their primary state.
7. Include the 'Area Code and Telephone Number' to ensure the Department can contact the dispenser for any follow-up questions.
8. Sign and date the form in the appropriate fields to authenticate your request.
9. In the section for 'Reason for request of exemption from reporting,' check all applicable reasons and provide any additional explanations needed in the space provided.
10. Review all entries for accuracy and completeness prior to submitting the form online.
11. Once you are satisfied with the entries, proceed to save your changes, download a copy, print it, or share the completed form as required.

Complete your SD DoH Request For A Waiver/Exemption From Reporting online today.